Jackson & Coker

Exclusive Survey-Expenses: Rising Costs Hit All Physicians --Industry News--

Fri, 07 Dec 2007 00:00:00 -0500

According to a survey issued by Medical Economics, the cost of running a medical practice continues to escalate due to increases in general expenditures like payroll, energy costs, office facilities, and malpractice and healthcare premiums. Other line item expenses vary depending on the type of practice. The following indicates the median annual cost for primary care practices, excluding bonuses or retirement/profit sharing contributions: Family practitioners: $235,000 General practitioners: $180,000 Internists: $200,000 Ob/gyns: $360,100 Pediatricians: $266,300 All primary care: $240,000 Ob/gyns and pediatricians, the two physician groups with the highest costs, generally use midlevel providers more frequently than their internist colleagues, thereby increasing their payroll expenses. With regard to pediatrician practices, immunizations are largely responsible for the high operating costs. Pediatricians’ median drug supply costs are $82,800 according to MGMA, compared to internists, who pay just over $8,000. Low reimbursement rates coupled with storage costs on vaccines mean that pediatric practices sometimes fail to break even on immunization costs. With regard to location, inner city physicians spend less and make less compared to their urban, suburban and rural peers. Conversely, suburban practices, with generally higher expenses, have to rely on higher patient volumes to offset more expensive facilities and higher rental rates. Suburban practices also add to their expenses by keeping longer hours to satisfy the schedules of commuting families.

Limits Weighed on Physician-Owned Hospitals --Industry News--

Sun, 09 Dec 2007 00:00:00 -0500

The recent debate surrounding Medicare pay reductions has reignited political interest in the politically contentious topic of physician-owned hospitals; namely, the question of whether physicians should be able to own the hospitals to which they send their patients. Senator Charles E. Grassley of Iowa, the top Republican on the Senate Finance Committee supports the reforms due to the allegedly negative effect that physician-owned “specialty hospitals” have on community hospitals. According to the senator, specialty hospitals “pass the buck” on emergency care and “cherry-pick based on profits rather than patient needs.” Traditional hospitals complain of lost business and conflict of interest, while the backers of physician-owned hospitals say they promote competition and improve the quality of care. Congress imposed a temporary moratorium in 2004 on establishing new physician-owned hospitals amidst lobbying pressure from both sides. The moratorium has since expired, and interest in the topic reemerged in August when the House passed a Democrat-sponsored measure that would limit physician investment in existing doctor-owned hospitals to 40 percent, and individual stakes to no more than 2 percent, while banning the creation of new physician-owned hospitals. The issue is unlikely to receive congressional action before the New Year.

Looming Medicare Pay Cut Forces Tough Decisions on Participation --Payer & Reimbursement Issues--

Mon, 31 Dec 2007 00:00:00 -0500

The narrowly avoided Medicare pay cut would have forced physicians to make a difficult decision before the New Year. In the event of a Medicare pay reduction, which may still happen in summer 2008, physicians that continue to participate in the Medicare program would endure a 10.1 percent reduction in medical fees from Medicare patients. Under the recently tabled Medicare package, physicians who opted to not participate in Medicare (non-PARs) could still see Medicare patients for a reduced fee by accepting “assignment” on a per-patient basis. Doctors who did not accept assignment would receive the Medicare rate and could balance-bill patients up to 15 percent more. Thus, non-PARS could receive up to 9.25 percent more in payment than participating doctors for the same service. However, non-PARs who did not accept assignment would not receive Medicare reimbursement directly from insurance carriers. Instead, Medicare would reimburse the patient directly and physicians would then invoice the patient for the full amount of payment, co-payment, and the balance-billing charge. Physicians with costly medical services could find themselves in dire financial situations if only a few patients failed to pay.

Real-Time Payment: What’s Holding it Back? --Payer & Reimbursement Issues--

Fri, 07 Dec 2007 00:00:00 -0500

Real-time claim adjudication (RTCA) has been in existence for several years, but few insurance plans have offered it. Recently, however, higher deductibles have increased the need for patients in high-deductible plans to know how much treatment will cost; moreover, healthcare providers want to collect payment at the time of service. To address these concerns, Humana, United Healthcare, and BlueCross BlueShield offer real-time claim adjudication in some states. Despite the growing need for RTCA, efforts to implement the practice have been thwarted by staffing problems and complex information exchange processes. Most problematic is that RTCA creates a dual data entry requirement under most current office practices. Practice management systems cannot transmit claims individually to particular insurance agencies, and RTCA is only offered on health plan websites. Therefore, practices that use RTCA have to enter claims twice: once on insurance websites and once in local databases, which effectively doubles the workload for support-staff. Even in the event that insurers could integrate systems to reduce the need for dual data entry, the time it takes for physicians to complete charge-tickets, deliver them to the billing office and have the data entered supersedes any time saved during the RTCA process. To address this matter, BlueCross BlueShield of South Carolina introduced the “superbill” feature, which permits practices to upload their top 100 procedures and diagnoses into the system, thereby reducing data entry time. Similarly, United Healthcare has introduced patient cards and card readers that can quickly transfer benefits and eligibility information. Nonetheless, RTCA still constitutes a meager percentage of the claims filed to health insurance agencies, even among payers that offer developed RTCA services.

Physicians Fight AETNA Over Caps on Out-of-Network Pay --Payer & Reimbursement Issues--

Mon, 14 Jan 2008 00:00:00 -0500

Aetna, one of the country’s leading providers in health insurance and products, angered many physicians nationwide recently by declaring that it will cap the amount of reimbursement paid to out-of-network doctors at 125% of Medicare. In some cases, such as Pennsylvania, in a mass mailing to doctors, Aetna declared that 125% was in accordance with the “maximum state mandate rate.” The Pennsylvania Medical Society, however, does not have a set rate as such. Physicians are also upset that Aetna has already informed patients that they will not pay “any bill a doctor might send to make up for costs and fees lost as a result of the insurer’s cap.” Organized medicine is complaining that this tactic is not only unfair, but is also within violation of a prior settlement agreement with physicians as part of a class-action lawsuit. This agreement declared that Aetna can not “disparage” nonparticipating physicians and also that each EOB can decide the amount for which a physician may bill a member. The AMA is in strong opposition to Aetna’s new policy, and AMA officials are fighting to regain immediate and full reimbursement to physicians for charges billed since Aetna introduced the cap.

FDA Approves Fewest Drugs Since 1983 --Industry News--

Tue, 08 Jan 2008 00:00:00 -0500

Business and financial outlet Bloomberg recently reported that the Food and Drug Administration (FDA) approved only 19 new drugs for all of last year, the lowest total since 1983. These recent numbers confirm the struggles and difficulty of drug companies to come up with new products. Of the 19 newly FDA approved drugs, 17 of them are molecular entities, meaning they are entirely different and innovative drugs. The other two approved drugs were biotech drugs. The companies with most approvals this past year were Novartis and GlaxoSmithKline, each receiving two approvals a piece. Many industry insiders blame the decreased approvals on tougher regulations and standards by the FDA. The FDA, however, defends its standards and claims that they have not altered their requirements at all. There are many hypotheses within the industry as to why there has been such a decrease in drug approval rates recently but none that are widely agreed upon or seemingly accurate. One of the more popular arguments from doctors is that the pharmacy industry has become too overpopulated and bloated as well as too bureaucratic and risk averse. It is also possible that the industry has shifted its efforts away from novel drugs and more towards modifying pre-existing medicines in order to fully maximize sales during this apparent research drought. It is also probable that the majority of the more simplistic drugs have already been found and that drug researchers will need a major scientific discovery or breakthrough before they can come up with any fresh and relevant drugs.

Be Careful What You Promise --Medical - Legal Matters--

Fri, 04 Jan 2008 00:00:00 -0500

When it comes to medical lawsuits and malpractice claims, it is very possible that the natural inclination of physicians to comfort and relieve their patients of pain and anxiety can, in reality, do the medical professional more harm than good. Doctors must be careful when they make simple assurances to their patients that they are not promising more than they can deliver, as lawsuits are derived primarily from two things: a patient with unrealistic expectations and a less-than-ideal medical outcome. There is limited opportunity for physicians to account for unexpected and undesirable results, but they are in complete control over their patients’ expectations. That is why it is so important for a doctor to keep these expectations realistic and not overly assuring. Lawsuits can be triggered by overly optimistic guarantees about outcomes or by downplaying potential risks. For a patient to claim a lack of informed consent, they only have to establish and prove that “he or she wasn't informed of the risks and alternatives that a reasonable person would have considered to be important in deciding whether to undergo the proposed treatment.” Likewise, in order for a patient to claim a breach of warranty, they only have to show that he or she “relied on the doctor's representations…in consenting to the procedure, and those representations turned out to be wrong.” This means that the patient does not have to prove any form of negligence on the doctor’s part, but simply that the outcome was not consistent with the representations and warranties with which they consented or if “the patient wasn't told about common risks and complications.” Even if a physician exceeds the standard of care, overly optimistic analysis or assurance can prove very costly in the long run. Although it is not required for physicians to go over every possible risk with a patient while proposing procedures, it is important that they thoroughly account for all of the major hazards and potentially adverse outcomes. Calming a patient’s anxieties is fine as long as the comforting is regulated enough to maintain reasonable expectations. It is more important for a patient to understand the procedures, and although things usually go as planned, there is always the possibility for adverse reactions and there are never any guarantees. This way, the patient should never be left with unreasonable expectations or a sense that any procedure is infallible.

U.S. Lags in Halting Preventable Death --Credentialing, Licensure, Quality Management--

Tue, 08 Jan 2008 00:00:00 -0500

Of the 19 industrialized countries surveyed for a recent study, the United States was the worst at stopping preventable deaths from occurring in people under the age of 75. If its preventable death rate matched or was comparable to those of top-ranked countries, the study concludes that the U.S. may have been able to spare an estimated 101,000 deaths annually. Not only did the U.S. receive the worst ranking in the survey, the study also showed that the country has the slowest rate of improvement. Using data that had been compiled by the World Health Organization, the researchers compared the preventable death rates of 19 countries between 1997-1998 and 2002-2003. The study defined preventable deaths as deaths in “people younger than 75 with treatable cancers, bacterial infections, diabetes, stroke, heart disease, and surgical complications.” The figures from 1997-1998 show that the United States was not the worst country in halting preventable deaths, but because of very little improvement in this category, the U.S. fell into the last position by 2002-2003. In that span, the United States only improved by a 4% rate of decline, compared to the 16% average rate of improvement in the other countries. Here is the full list of how the 19 countries ranked in their preventable death rates for 2003-2003: 1. France 2. Japan 3. Australia 4. Spain 5. Italy 6. Canada 7. Norway 8. The Netherlands 9. Sweden 10. Greece 11. Austria 12. Germany 13. Finland 14. New Zealand 15. Denmark 16. U.K. 17. Ireland 18. Portugal 19. United States

Healthcare Spending Reached $2.1 Trillion in 2006, CMS Says --Industry News--

Tue, 01 Jan 2008 00:00:00 -0500

Figures recently released by the Centers for Medicine and Medicaid Services put American healthcare spending at $2.1 trillion dollars for 2006. The figures indicate price and spending increases in virtually every aspect of the healthcare industry. The growth of spending indicates an accelerating pace of increase in healthcare spending which outstrips overall economic growth and the national rate of inflation. The CMS report also portrays a growth in out of pocket spending of 3.8% as well as increases in private health plan premiums (up 5.5%) and overall prescription spending (up to $216.7 billion).

Medicare Spending Rose 19% in 2006 --Industry News--

Tue, 08 Jan 2008 00:00:00 -0500

According to a recent report in Health Affairs, Medicare spending for 2006 increased at a faster rate than it had in the previous twenty-five years. In 2006, health care spending amassed $2.1 trillion, accounting for nearly 16% of the American economy, an increase of 6.7% from the year before. This rise in Medicare spending is due in large part to an increase in prescription drug benefits for the disabled and elderly. In contrast, Medicaid spending dropped 0.9% in 2006 to $176 billion. This is primarily because over 6 million senior citizens switched from Medicaid to Medicare programs in 2006. These numbers indicate that health care spending is still increasing faster than the rest of the economy and that the cost of medical services continues to grow at a faster rate than the average income of Americans. The total amount of spending on drugs rose 8.5% in 2006, a rise from the 5.8% increase in 2005. Total prescription drug spending for 2006 was nearly $217 billion. However, the authors point out that roughly 63% of all prescriptions administered in 2006 were for generic drugs, compared to only 56% in 2005. The report also illustrates that just about a third of all US health spending is consumed by hospital care alone (31%). The 31% spent on hospital care can be broken down into physician services (21%) and prescription drugs (10%).

Medicare to Require Physicians to Use New ID Numbers on March 1 --Industry News--

Mon, 14 Jan 2008 00:00:00 -0500

Beginning on March 1st, all physicians who bill Medicare electronically will also have to provide their national provider identifier (NPI), as well as any other former IDs that they may have been using. In the recent past, the Medicare program has allowed physicians to file with just their older, “legacy” identifiers while they wait to attain their new NPIs. This policy was to insure that the personal data attached to all of the numbers on the NPIs were not mismatched. After May 23rd of this year, physicians will be required to make all of their electronic claims to Medicare and other health care payers using only their NPIs. This deadline entails that all identification discrepancies have to be handled and corrected by then. All physicians that file claims electronically must comply with these issued deadlines, however, these deadlines do not apply to any physician who files paper claims. Many physicians are against the transition to the new identification policies and deadlines because of the ineffectiveness and disorder already created by the NPIs. In September of 2007, the Centers for Medicare & Medicaid Services requested that carriers stop accepting claims from any physician whose information did not match between their new NPI and their older identification numbers. This created several problems for physicians, including failed Medicare payments. Despite recent efforts made by the American Medical Association and the Medical Group Management Association, CMS will not likely postpone or retard the set deadlines for establishing a highly desired NPI-only system. The CMS claims that the majority of Medicare claims being filed by physicians electronically are being processed without incident and that only roughly 10% of all claims continue to be devoid of an NPI. The CMS claims that when they made the orders in September to reject any mismatched filings, the subsequent rejection rates were rather low. Still, the AMA and MGMA insist that those effects were significant. Although the majority of the problems between the physicians and their carriers are being adjusted in a timely fashion, many physicians still continue to experience troubles with their electronic claims and payments.

Physicians Gain New Tool to Better Manage Acute and Chronic Pain --Industry News--

Wed, 09 Jan 2008 00:00:00 -0500

Some physicians are getting a beneficial new tool for managing chronic pain. The Federation of State Medical Boards Research and Education Foundation (FSMB) is offering a new handbook to all physicians. The FSMB is a national non-profit organization that represents seventy medical boards of the United States and works to ensure and improve “the quality, safety and integrity of health care by developing and promoting high standards for physician licensure and practice.” The handbook, Responsible Opioid Prescribing: A Physician’s Guide, is intended to further assist doctors in handling their patients’ acute or chronic pain. The book offers actual explanations and practical strategies that “address issues of undertreatment of pain, risk of prescription drug abuse and improved patient care.” As funds are raised, FSMB is offering medical boards, on a state-to-state basis, print copies of the book to be distributed to physicians across the United States. It is estimated that upwards of 750,000 physicians across the country will receive one of these handbooks. The guides can also be customized from state-to-state to include particular state-specific statutes, policies, and rules and regulations. The handbook is based on FSMB’s Model Policy for the Use of Controlled Substances for the Treatment of Pain. The book covers a wide variety of topics, including recommendations for: Ensuring effective patient evaluation Creating a function-based treatment plan with actionable patient goals Obtaining a written patient-physician agreement that includes informed consent and significant patient education Overseeing periodic review that focuses on progress toward functional goals Making specialist referrals and managing difficult patients Creating and maintaining clear, consistent, transparent and detailed documentation Remaining up-to-date on federal and state controlled substance policies

FCC Dedicates $417 Million to Expanding Rural Telehealth Systems --Industry News--

Mon, 17 Dec 2007 00:00:00 -0500

In November, the Federal Communications Commission allotted $417 million over a three-year period to the expansion of telehealth services in rural communities across the United States. The effort, as part of the Rural Health Care Pilot Program, will fund construction of statewide or regional broadband telehealth networks in 42 states and three U.S. territories. The FCC had originally planned to allocate $100 million over two years but expanded the program after receiving more applicants than anticipated. The pilot program will now help fund telehealth connections for more than 6,000 physicians, health professionals and facilities. Rural physicians typically lack the high speed internet access necessary for telehealth services. Basic internet service exists but cannot support the high bandwidth necessary to transmit medical records, radiological readings or video conferencing. The funds will be used to install or develop a range of services, including higher speed computer connections, fiber optic cable installation, and high-speed internet at the homes of on-call physicians. The effort is expected to dramatically improve telehealth capabilities of rural physicians across America.

Tax Credits for EMRs --Industry News--

Mon, 03 Dec 2007 00:00:00 -0500

A new AMA policy on health information technology attempts to address physicians’ cost concerns surrounding electronic medical records. While there is a clear push for physicians to adopt EMRs, many cannot pay for the technology that private payers and government agencies are requesting. While EMR use has been growing steadily, widespread use would require financial help for doctors, especially those in small practices. Consequently, the AMA approved a policy calling for a full, refundable federal tax credit or equivalent financial mechanism to cover physician practices for the costs associated with purchasing and implementing clinical information technology. In fact, Health Affairs reported that in 2005, initial EMR costs averaged $44,000 per physician with an additional $8,500 of annual costs. With Medicare payments set to drop, it is only reasonable to help physicians mitigate information technology costs. Accordingly, the AMA has encouraged Congress to make sure physicians are not disproportionately burdened with the cost of developing and maintaining a national health IT network benefiting all sectors of the industry. They feel a federal tax credit program would encourage physicians to adopt the technology.

CMS Readies Test of New Assessment Tool --Industry News--

Mon, 17 Dec 2007 00:00:00 -0500

Centers for Medicare and Medicaid Services (CMS) will begin testing the new Continuity Assessment Record and Evaluation (CARE) system, a tool designed to determine post-acute care payouts, in 2008. The three-year system demonstration will take place in 10 to 15 markets, representing roughly 150 providers across a variety of healthcare organizations. The current CMS tools used to gauge Medicare payment – IRF-PAI, MDS and OASIS – are incompatible with one another and utilize different measurement scales. CARE will address the current incompatibility issues and lack of centralization by using standardized data formats and a single web-based application for claims submission. According to a CMS White Paper on the new system, CARE is also a potential vehicle for all healthcare providers to standardize patient data while incorporating changes in evidence-based medicine. The three-year trial period will be used to measure treatment and outcomes of patients in post-acute-care setting in four domains: cognitive impairment, medical, functional, and social/environmental factors. Starting in January 2008, providers can submit reports directly to CMS via internet. CMS will eventually develop interoperable systems that will permit physicians to upload stored patient information and reduce data entry time. In response to the disclosure of CARE, the American Hospital Association noted that the tool has the potential to streamline hospital discharge planning but that general acute-care hospitals will suffer a massive resource burden from the cost and time required to conduct sufficient reporting.

Physician Recruitment in the Wake of Stark III --Staffing & Recruitment--

Sat, 01 Dec 2007 00:00:00 -0500

The Centers for Medicare and Medicaid Services published their final rules regarding physician self-referral prohibition in September of 2007, making drastic changes to the Physician Recruitment section. Stark, the name by which the regulations are best known, holds that funds paid directly to a recruited physician by a recruiting hospital with the purpose of inducing the physician to relocate his practice to within the geographic area served by the hospital are protected if the following four conditions are satisfied: The arrangement is set out in a signed written agreement. There is no condition in the arrangement that the physician refer patients to the hospital. The funds paid to the physician are not based on the volume or value of any actual or anticipated referrals by the physician or other business generated between the parties. The physician is permitted to establish staff privileges at other hospitals and to refer business to any other entity. The Stark rules were amended to clarify and loosen regulations on what constitutes a “served geographic area” around a hospital to include all contiguous zip codes within that area. Previously, under-populated areas and areas from which a hospital drew a low percentage of its clientele were disallowed from inclusion. The regulations governing the necessary distances to which a physician must relocate his practice when recruited were also modified to clarify policy. Alterations were also made to policies loosening restrictions on the recruitment of physicians in rural and small communities.

Bringing in Rural Physicians --Staffing & Recruitment--

Tue, 01 Jan 2008 00:00:00 -0500

The national health worker shortage is acutely felt in underserved and understaffed rural areas. An article in the January issue of Trustee addresses the problem and offers a few solutions for rural hospital and practice administrators. Over the next fifteen years, demand for physicians will outstrip growth as the “baby boom” generation ages and becomes eligible for retirement. Physician, nurse, and practitioner shortages will be felt more and more, and attracting doctors to rural areas is a crucial consideration, as some thirty million Americans live in these underserved areas. This is not solely a crisis, however. The authors view this as an opportunity for trustees to step up their interactions with their hospitals in order to aid in recruitment. A number of helpful hints for recruiting are provided. Trustees looking to attract doctors to rural areas must be willing to: Interweave physician and family into the community. Physicians moving to a new area will need to feel welcomed in order to make them more likely to stay. Provide aid in envisioning life in a given community. Letting potential staff know the possibilities of an area is essential in helping them to imagine their life there. Provide aid in social integration. Top board members must be ready and able to take a personal role in welcoming new staff. Outreach is essential. Top staff need to step up recruiting efforts at medical schools. Administrators are advised to look at their best doctors and use them to recruit heavily at the schools that they come from. Play up the benefits of rural remoteness. Administrators can turn remoteness into a positive factor by demonstrating the hospital’s commanding regional market share, the range of possibilities open to a recruit, and the financial benefits of leveraged contracts with payers. Allow doctors a range of freedom. Administrators must be ready to allow recruited doctors to practice medicine the way they want to, within the bounds of safeness and regulations, of course. Realize the possibly disadvantaged position of the hospital with regards to location and incentivize appropriately. Work-life balance, payment, and other benefits must be made as enticing as possible to lure recruits.

Pilot Program Aims to Train Spanish-Speaking Doctors --Staffing & Recruitment--

Thu, 18 Jan 2007 00:00:00 -0500

A pilot program at the University of California–Los Angeles targets the surplus of medical-school graduates from Latin America to address a shortage of Spanish-speaking doctors in the United States. A record influx of Latin American immigrants into the U.S. has left clinics and hospitals across the U.S. to grapple with Spanish-speaking patients. Poor communication can result in millions of dollars annually in unnecessary testing, emergency room visits, delayed or inaccurate diagnoses, or noncompliance with medical instructions. UCLA’s pilot program prepares participants for U.S. medical board exams and issues a stipend to medical school graduates of Latin American countries. Upon completion of their residency, participants are required to spend at least three years in medically underserved areas in the United States. Prior to starting the program, most participants had been working in the U.S. as X-ray technicians, nursing assistants, or healthcare volunteers. The program will complete its first year in February 2008 with only 14 participants. Administrators plan to replicate the program at other University of California campuses, and according to the chairman of the Department of Family and Community Medicine at the University of Texas Health Sciences Center in San Antonio, the Texas system is also considering implementing similar programs to address the state’s shortage of Spanish-speaking doctors.

Reaching Out to Different Cultures --Staffing & Recruitment--

Sat, 01 Dec 2007 00:00:00 -0500

Understanding and accommodating diverse cultures is a successful and beneficial approach to dealing with the issue of diverse patient populations. So says the chairman of the Health Financial Management Association in an article in the December issue of HFM Magazine. The author cites the outreach efforts of the New York Downtown Hospital, a 150-bed hospital in Lower Manhattan. Fully 80% of the hospital’s inpatients are Chinese. Of these, a sizeable amount are immigrants with insufficient or non-existent English skills. In response, the hospital has brought on translators and a number of staff of Chinese descent. The hospital also engages in outreach programs, offering health screening and health education opportunities at community fairs in Chinatown. The policy of outreach has yielded great benefits. The Chinese community in Lower Manhattan now has much improved access to health care. The hospital has increased its market share of inpatients in that region as well and reports a greater number of births among the Chinese community as the hospital has increased its connections with a fast growing segment of the population. The chairman cites the New York Downtown Hospital as a great example of an organization making a real difference in its community through the use of genuine outreach, proclaiming it an example for all to take to heart.

Partner or Employee: How to Decide --Employment & Compensation--

Thu, 01 Nov 2007 00:00:00 -0400

In today’s private practice world, the road to partnership is sometimes shorter than ever. But is taking on a partnership role in a practice the safest career move? An article in Medical Economics examines the possible benefits and pitfalls of partnering up. The authors point to a number of benefits to partnership. Becoming a partner in a firm can lead to a sizeable boost in income, and there is also the benefit of a greater deal of autonomy on the part of a partnering physician. Partners are furthermore better able to build up equity in a firm, and—in the event the firm is sold or brought under another hospital—the partners are able to share in the rewards and profits of such a transaction, whereas a physician who is solely an employee cannot share in these benefits. However, a number of detractors to the partner status are also inherent. Partnership requires a buy-in, and the financial stake taken in a firm comes without guarantee of repayment or profitability. If the practice goes under, that money is lost. Besides the heavy financial risk, there is also often a heavier workload. This can lead to added stress and decreased morale if things aren’t going well. Partnership also requires a greater deal of administrative work, which may not sit well with physicians looking solely to practice and leave paperwork to others. Lastly, there is no guarantee of a retirement package or a buy-out from the practice, as these things must be negotiated separately. Keeping these factors and possibilities in mind, a physician is more fully able to weigh the pros and cons of partnering up. It is ultimately up to the individual to decide if partnering with a particular firm is the best career choice.

10 Things You Should Know About Locum Tenens --Employment & Compensation--

Tue, 01 Jan 2008 00:00:00 -0500

An article in the January 2008 issue of Locum Life offers helpful hints to physicians looking to become locum tenens practitioners. The authors asked industry experts, seasoned locum tenens physicians, and registered nurse anesthetists for their insights on locum tenens as a practice alternative. Their answers shed a good deal of light on the practice. Locum tenens practitioners generally fall into three categories: recent graduates, physicians between jobs, and retired or semi-retired professionals. Locum tenens is attractive to physicians due to the range of experience available in such a practice. Locum tenens professionals need to look for staffing firms that will provide regular pay, malpractice coverage, and credentialing assistance. These things can be set up by a physician on his own, but the use of a staffing firm generally makes for an easier and more pleasant experience. Locum tenens need to take the initiative in the credentialing process in order to ensure that it is properly completed. Locum tenens professionals are able to practice in a variety of settings in both governmental and commercial roles. Movement between these two spheres is limited by regulations, of course, but navigation between them is both doable and advisable for a richer locum tenens experience. Locum tenens should utilize their staffing firms to secure transportation and housing arrangements. Practitioners should be sure to be aware of key aspects of their contract arrangements with regards to the practice. All contracts should be thoroughly reviewed to ensure job stability and proper compensation as well as the absence of conflicts of interest. Practitioners should be aware of the contractual obligations of working in a given facility. Locum tenens professionals can be successful if they keep an open mind as to positions, career paths, tenures, and compensation packages available to them due to their particular status.

Pay is Up; Profit Still Elusive --Employment & Compensation--

Fri, 12 Jan 2007 00:00:00 -0500

Physicians around the country saw another increase in their compensation in 2006, and productivity jumped up as well, according to numbers released by the American Medical Group Association. An overall increase in compensation was recorded, with an average increase of 4.8% for physicians. The two highest increases were reported for pulmonary disease and infectious disease specialists, which reported 11.5 and 9.6% growth respectively. Productivity was also reported to be up 7% across the industry. Despite these numbers, physician groups appear to be operating at a loss in all regions of the US except for the West. Western groups reported an average profit of $17,317 per physician, while groups in the South reported a loss of $6,049 per physician. This loss is likely attributable to capital expenditures on information technology, the payer system, and patient education. The study was based on physician group responses to a mailed survey. There were responses from 222 physicians groups across the country.

Physicians Challenge Lawyers’ Meritless Liability Suits – And Win --Medical - Legal Matters--

Mon, 03 Dec 2007 00:00:00 -0500

The American Medical Association reports a series of favorable court rulings is changing physicians’ battle against frivolous medical liability lawsuits. Over the past six months, numerous courts throughout the U.S. have chastised attorneys for gratuitous behavior including suing the wrong doctor, refiling a claim against a physician even though the plaintiff's expert withdrew his testimony the first time around, and having no expert testimony against one doctor, yet failing to drop the case. While not trying to prevent legitimate claims, doctors are hoping these victories will send a message deterring lawyers from filing those that are baseless. Furthermore, there is the hope that the rulings will encourage trial judges who see abusive conduct to take action while demonstrating to physicians that the system is not completely stacked against them. Furthermore, proactively challenging meritless cases is a way to reduce the frequency of bad claims and curb rising liability insurance costs. Dr. Jeffery Segal, founder of Medical Justice - a company that sells insurance policies giving doctors legal resources to combat frivolous claims - pointed out that when a client physician receives notice that a patient is considering filing a lawsuit the doctor believes is frivolous, the company sends a letter to the lawyer that the physician may counter-sue. Segal explained that as a result, only 11 percent of these instances then materialize into a lawsuit. Trial lawyers agree that punishment may be justified when an attorney completely eschews responsibility by pursing a case. However, they feel this conduct is rare because there is no moral or economic incentive for plaintiff lawyers to file frivolous cases as they take on the often expensive and complicated negligence suits in bad faith.

AG: $600 Million in Medicare Fraud Prosecutions Just a Start --Medical - Legal Matters--

Sun, 14 Jan 2007 00:00:00 -0500

The South Florida Medicare Fraud Strike Force quadrupled the number of individuals charged with filing false claims in 2007. The disrupted schemes amounted to more than $600 million in fraudulent claims. In 2005, South Florida had 10 percent of the nation’s Medicare patients with HIV/AIDS, but accounted for $2.21 billion of the nation’s $2.31 billion in HIV Medicare drug claims, according to the Department of Health and Human Services. Prior to the creation of the task force, the US attorney’s office for the Southern District of Florida charged 58 individuals in 53 cases in 2005, as compared to 197 people in 120 cases in 2007. The attorney’s office works in conjunction with the FBI, CMS and the Florida Department of Health. Prosecutions have been primarily focused in two areas: durable medical equipment and HIV infusion therapy to administer drugs. The legal action has allegedly acted as a deterrent for false medical claims in other medical practices.

Employers Tell Workers to Get Healthy or Pay Up --Medical - Legal Matters--

Tue, 04 Dec 2007 00:00:00 -0500

U.S. companies are increasingly using financial incentives to motivate workers to kick unhealthy habits, such as obesity and smoking. Employers that rewarded employees for participating in wellness programs are now opting to penalize those with bad habits that do not. Indeed, employees at some companies who are overweight, smoke, or have high cholesterol that choose not to participate in supplementary wellness programs will now be required to pay more for health insurance. Some employees' insurance deductibles could rise by as much as $2,000. While employers want to see results, consultants and lawyers agree that interfering with workers’ lifestyles through financial penalties risks lawsuits or may even violate the Americans with Disabilities Act.

$200+ Million Verdict: It Started with a Midlevel’s Mistake --Medical - Legal Matters--

Fri, 07 Dec 2007 00:00:00 -0500

Last year a Tampa jury awarded $217 million, including $100 million in punitive damages, to a man whose cerebellar stroke was misdiagnosed as sinusitis and who consequently suffered irreversible neurological damage. The verdict, one of the largest malpractice awards in U.S. history, stemmed from a medical group’s improper use of an unlicensed physician assistant, a purportedly negligent doctor and infighting between the medical group and the malpractice insurance agency. The physician, Dr. Austin, and the physician assistant, Mr. Herranz, were both employed through a medical group, Frank, Favata & Hulls, MDs, which was contracted with the hospital to manage its emergency department. Herranz recorded the patient’s history and symptoms, and Austin misdiagnosed “sinusitis/headache” based upon the information provided in the report. Dr. Austin did not repeat any exams. The medical group would reveal 16 months later that Herranz was an unlicensed physician assistant, which Austin was unaware of at the time. The medical group also held Austin and Herranz accountable for the misdiagnosis. In the verdict, Herranz and Austin were each found 25 percent liable for compensatory damages, while the medical group was accountable for the other 50 percent. The malpractice insurer, ProNational Insurance, refused to settle the case for $2 million prior to the trial, which spurred Austin and the medical group to sue the insurer for not making reasonable attempts to settle, thus leaving Austin and Herranz personally exposed for compensatory damages. Medical Economics recommends that in cases with multiple defendants, the possibility of an excessive verdict exists, and that physicians should therefore hire individual counsels to provide protection beyond that offered by the malpractice insurance agency.

2007: The Year That Was in Radiology --Medical Specialty Focus--

Sat, 01 Dec 2007 00:00:00 -0500

For imaging professionals, 2007 was a year filled with political, social, and industry happenings that will have effects for some time to come, according to a piece in the December issue of Advance. 2007 was the year in which the “baby boom” generation—the nearly 80 million Americans born between 1946 and 1964—first began to be eligible for social security and retirement benefits. The oncoming wave of boomer retirees are 50% more likely to need an imaging procedure than are younger Americans. This will inevitably lead to a surge in work and demand for imaging technologists. Last year also squarely placed healthcare at the forefront of American political discourse. The author points out an upcoming health worker shortage which is bound to have an impact on the industry and must be addressed if improvements are to be made in the American system. The past year also saw the rise of teleradiology: an innovative communications technology allowing for review of imaging results from remote locations over the internet. In the future, this is likely to lead to a revolution in imaging, as smaller hospitals are able to employ off-site professionals that would otherwise be unavailable to them due to cost or geography. The author, taking all these factors into account, presents a generally positive view of the year that was and a brightly optimistic estimation of what is to come in 2008.

Writing About Patients: the Perennial Dilemma --Medical Specialty Focus--

Sat, 01 Dec 2007 00:00:00 -0500

What are the ethical implications of writing for press about a psychiatric patient? An article in Psychiatric Times addresses the ethical dilemma facing doctors caught between informing their peers and preserving patient privacy with an eye toward striking a balance between these two essential duties of psychiatrists. The article examines the plusses and minuses of obtaining patient consent before publication. It is argued that, while informative for the psychiatric community, publication of certain cases can, if insufficient in protecting the patient’s identity, run the risk of setting back treatment program progress or even bringing about relapse in particularly on-edge patients. The author argues that, while publication of cases is a beneficial act for the psychiatric community, patient confidentiality must remain the highest ethical concern. Therefore, all means should be taken to ensure that publication of the article does no harm to the patient in question. The article concludes that clinical publishing decisions must be made after fully taking individual case characteristics into consideration. This consideration must decide the appropriate level of confidentiality to be used or the degree of forewarning a patient should have about the publication of the study.

Increasing Rates of Emergency Department Visits for Elderly Patients in the United States --Medical Specialty Focus--

Fri, 07 Dec 2007 00:00:00 -0500

In 2005, the Centers for Disease Control and Prevention reported an increase in emergency department visit rates per 100 people. The greatest increase in visit rates was among individuals 65 years and older. Given that older ED visitors typically require longer lengths of stay, are more likely to be admitted, and compose a growing percentage of the American population, the increase in ED visits may have a significant effect on ED crowding. If the trend continues, annual ED visits in the US for 65 to 74 year-olds could almost double from 6.4 million to 11.7 million by 2013.

Studies Show Increasing Strain on Emergency Departments --Medical Specialty Focus--

Wed, 12 Dec 2007 00:00:00 -0500

According to a study released by the Center for Studying Health System Change, a difficulty in receiving payments from uninsured patients contributes to an increased reluctance among specialists to work in emergency departments. The study results are based upon visits to 12 health facilities in representative metropolitan areas across the United States. Payment issues and a greater risk of malpractice lawsuits have spurred many specialists to open private practices. Hospitals have attempted to lure specialists to work in emergency departments through higher compensation, but such methods have led to an increase in costs for patients and insurers.

Payer Trend: ‘Tiering’ Physicians and ‘Steering’ Patients --Payer & Reimbursement Issues--

Sat, 01 Dec 2007 00:00:00 -0500

An article in the November/December issue of Family Practice Management examines the controversial practice of “tiering and steering,” wherein payers rate the efficiency and quality of practices based only on claims data. This data is later shared with patients and has the potential to negatively affect the bottom line of practices. Tiering and steering—also known as “physician profiling” or “economic credentialing”—has, as of recent, become a computerized method of physician cost-efficiency analysis by which a growing number of payers analyze physician claims data, compare it to that of their peers, and use this information to create tiered networks of physicians toward which they can then steer specific patients in order to save on payer costs. While the practice has a generally positive effect on payer finances, there are possible flaws in the system for physicians. For one thing, the system doesn’t necessarily take into account the number of episodes of care that could have been prevented by primary care, such as complications due to diabetes or congestive heart failure. These profiles of doctors are typically constructed on tiers based on differences in care costs among physicians, but without proper input, they can fail to provide a true glimpse of the cost and quality of care provided by a particular practice. Doctors are advised, in light of the system, to retain as much pertinent data on their practices as possible. Retention of such data would allow them to counteract any negative or incomplete information a payer may generate to classify a practice. This sort of capability can be instrumental in challenging an inaccurate rating from a payer, ultimately improving both the reputation and bottom line of a practice.

You Can Negotiate with Health Plans --Payer & Reimbursement Issues--

Fri, 04 Jan 2008 00:00:00 -0500

While doctors, especially those in small practices, can sometimes feel overwhelmed and helpless in negotiations with health insurers, there are a number of useful tips and guidelines for how to bargain with major health plans for better compensation. Due in large part to insurance industry consolidation, competition among insurance providers has become more limited. With this said, many physicians have much more bargaining power than they may believe. The first significant suggestion is for doctors to go right after health insurers because, if nothing else, simple negotiations can prove that lowball reimbursement is nothing more than an inadvertent mistake. Depending on a doctor’s location, specialty, and the size of one’s practice, insurers will do whatever it takes to keep them happy. In any negotiations, it is critical that one comes thoroughly prepared. When dealing with health insurers, it is rarely cunning debating and gamesmanship that thrive but rather commonplace information – more specifically, dollar figures for billing codes. It is important for a doctor to compare what private payers tend to pay for their top codes in order to identify any inconsistencies in how they are reimbursed by individual payers. Comparing fees and payer reimbursements can often develop more bargaining points. Preparing for a negotiation is essentially the same as developing a compelling argument. Whether a physician wants an insurer to collectively raise its rates or increase them on a selective basis, there needs to be a convincing reason for them to do so. A physician can, for example, make the claim that their practice is necessary for its market. Although this may not work in metropolitan areas due to the plethora of practicing physicians, this argument should be more effective in rural and suburban markets. A physician should also make it clear to an insurer that they improve the insurer’s bottom-line and can be viewed as a money saver. One should always have an answer or follow-up question prepared for any possible line that the insurers might throw out. This is all a part of being exceedingly prepared so that nothing can disrupt the negotiation. Finally, the subtext of any good negotiation should be the threat of walking away. Any doctor negotiating with a health insurer should make it understood that they are willing to walk away from any deal and will not be bullied.

Insurers Seek Bigger Reach in Coverage --Payer & Reimbursement Issues--

Wed, 19 Dec 2007 00:00:00 -0500

The insurance industry revealed on December 19th a series of steps that would permit more US citizens, even those with serious health problems, to obtain affordable healthcare premiums. The proposals, approved by America’s Health Insurance Plans (AHIP), would make it harder for insurance agencies to cancel or deny coverage to people with pre-existing medical conditions, while simultaneously limiting the premiums that could be charged to those people. The proposals are meant to address the 47 million Americans without health coverage and reflect a readiness among insurers to extend coverage beyond the healthiest Americans. Nevertheless, AHIP still recommends that states cover the most costly individuals while private insurers offer policies to everyone else. Political analysts regard the AHIP proposals as an attempt to counter mounting political pressure from Congress and Democratic presidential candidates. The move is also a means of maintaining relevance in any state legislative processes in order to prevent another highly regulated approach like that adopted in Massachusetts. States, however, are not likely to accept the proposals given the high cost of insuring the least healthy Americans.

Docs Spared Medicare Cut by the Senate --Payer & Reimbursement Issues--

Wed, 19 Dec 2007 00:00:00 -0500

Physicians will likely evade a Medicare pay cut for January 2008 after the Senate approved a deal to table a 10.1 percent pay reduction. Instead of a Medicare cut, physicians will receive a 0.5 percent pay raise ($6 billion) from Medicare and the matter will be postponed for six months until the summer of 2008. The temporary Medicare pay package still requires approval from the House and the President’s signature, both of which are likely to happen.

Stricter Requirements Sought for Relicensure as Medical Boards Draft Proposal --Credentialing, Licensure, Quality Management--

Mon, 31 Dec 2007 00:00:00 -0500

State medical board leaders are considering plans to augment requirements for the maintenance of physician licenses. In most states, physicians can presently maintain licenses by avoiding disciplinary actions and by completing a minimum number of hours of continuing medical education. The Federation of State Medical Boards (FSMB), however, is now considering new requirements that would render the continuance of physician licenses a process similar to the maintenance of specialty certificates. According to a draft report issued in November by FSMB, the federation recommends that physicians applying for relicensure participate in self-evaluation and practice assessment, demonstrate continued competence in areas like patient care and medical knowledge, and complete exams in practice areas. Physicians have challenged the proposal as an unnecessary duplication of the specialty board certification process, which already demands medically specific knowledge. The new requirements will be voted on at the FSMB House of Delegates in May 2008. Public comments are accepted on the proposal until January 7, 2008. The final report will be submitted to the federation’s board in February of next year.

Fight over Physician Quality Ratings Moves to Massachusetts --Credentialing, Licensure, Quality Management--

Mon, 31 Dec 2007 00:00:00 -0500

Group Insurance Commission (GIC), the Massachusetts state employee health insurance program, recently mandated a tiered system of physician rankings to imitate the model used in New York state. In November, GIC began accepting proposals from health plans to create networks covering 250,000 state employees and potentially another 330,000 municipal employees. In April, the commission released its first network-based physician quality ratings. But, amidst the expansion of the GIC network, physician unrest spurred the Massachusetts Medical Society (MMS) to condemn the commission’s tiered networks. Allies of MMS included state legislators supporting House and Senate bills that would govern standards for tiered network and BlueCross BlueShield of Massachusetts, which refused to submit a plan proposal to GIC. According to physicians in the state, the GIC health plans sent notices to physicians informing them of their ranking. The notifications offered no explanation or opportunity to appeal the rankings, which are based largely on cost of care instead of quality of care.

Study Finds Gaps between Doctors’ Standards and Actions --Credentialing, Licensure, Quality Management--

Tue, 04 Dec 2007 00:00:00 -0500

A study funded by the Institute on Medicine as a Profession published in the Annals of Internal Medicine uncovered notable gaps between physician ideals and practice, particularly in the areas of self-regulations, financial conflicts, and conserving limited resources. Nearly half of all physicians do not report incompetent or impaired colleagues even though 96 percent agree such people should be reported. Moreover, nearly half failed to report at least one serious medical error they observed. Researchers found large gaps between physicians’ adopted attitudes and what they actually practice. They agree that failing to report incompetent physicians affects the welfare of patients and should be brought to their attention. The study's authors and a panel of experts said that not all the findings were negative and that some must be understood in context. For instance, the fact that doctors nearly unanimously agree on standards means they do not need to be convinced that these issues are important. However, the experts agreed that physicians are trying to do the right thing and note that a renewed focus on professionalism, not simply more regulation, is necessary.

Can Patient Flow Analysis Reduce Patient Wait Times? --Healthcare Technology--

Mon, 01 Jan 2007 00:00:00 -0500

A study published in BMC Health Services Research utilized patient flow analysis (PFA) techniques at two clinics to identify inefficient areas of the care process and measure intervention effectiveness, with results suggesting that PFA is a valuable tool in increasing the efficiency of hospitals. The experiment first observed the normal routine of two clinics, one handling chronic pain and the other devoted to anticoagulation. The study’s authors performed a patient flow analysis on both clinics and devised interventions meant to improve the flow of both clinics by eliminating redundancies and restructuring inefficient elements. Interventions involved the relocation of laboratories, the restructuring of nursing staff, and the inclusion of increased numbers of clinical support staff in the anticoagulation clinic. In the chronic pain trials, the researchers altered policy to improve clinic triage, moving paperwork review issues to the beginning of the visit and allowing patients to get to see a doctor faster. Results suggested that the PFA and interventions led to sizeable decreases in patient wait time. The chronic pain clinic showed a mean visit time that was 25 minutes shorter than before the PFA. The anticoagulation trial resulted in a 39 minute (66%) reduction in total visit time for patients. The study’s authors believe that their results evince the efficacy of Patient Flow Analysis as a corrective tool for hospital organizations. They contend that PFA can function as an effective substitute for outside consultants, allowing clinic staff familiar with patient care processes to develop a greater sense of ownership, aiding in the resolution of problems and improving the clinical experience for all involved.

Illinois-Based Health System Brings EMR to Community Physicians --Healthcare Technology--

Mon, 07 Jan 2008 00:00:00 -0500

Provena Health has developed plans to provide an electronic medical records system (EMR) to its affiliated physicians. The 1,800 physician health system in Illinois and Indiana will host Misys EMR and Misys Tiger practice management software from Provena Saint Joseph Medical Center in Joliet, Ill. Provena is hosting EMR software as a way of encouraging a widespread adoption of EMR among its affiliated physician group (Alliance Health), as well as to cut costs associated with implementation and support. The Misys software products being utilized by Provena Health are provided by Misys Healthcare Systems based in Tampa, Fl. In addition to the EMR for physician practices, Provena Health has also purchased Misys Homecare, which the Catholic Health System will use among its network of home care nurses. Alliance Health also intends to implement Misys Payerpath software designed for billing and transactions. Such an integrated system would enable physicians to more precisely document care delivery and any subsequent results. This system will also prepare them for pay-for-performance initiatives. Provena is a health system that operates out of Illinois and Indiana and “includes six hospitals, 16 long-term care and senior residential facilities, 28 clinics, five home health agencies and other health-related activities.”

Cancer Patients Gain from Reporting Symptoms Online --Healthcare Technology--

Fri, 30 Nov 2007 00:00:00 -0500

A study published in the Journal of Clinical Oncology by researchers from the Memorial Sloan-Kettering Cancer Center suggests that having cancer patients report to doctors on their symptoms and side effects online may improve their care. As cancer care becomes increasingly complex, office visits become more compressed, making it challenging for clinicians to assess and classify symptoms. Furthermore, cancer therapies are highly toxic, so early detection and timely treatment is vital. Researchers agree that the online self-reporting option is beneficial because it allows all patients, even the sickest, to alert clinicians to crucial symptoms in real time. The study assessed over a hundred lung cancer patients that were presently receiving outpatient chemotherapy. These patients were provided access to a secure Internet patient reporting system referred to as Symptom Tracking and Reporting (STAR), which was developed by researchers at the Memorial Sloan-Kettering Cancer Center. Patients were able to use computers in waiting room kiosks and at home to report cancer symptoms and chemotherapy-related side effects. The study found that 98 percent of patients found STAR easy to use, 90 percent said it was useful, and 77 percent believed it improved the quality of their discussions with clinicians.

Minnesota Insurer’s Web Sites Allow Members to Post Comments About Physicians --Healthcare Technology--

Wed, 19 Dec 2007 00:00:00 -0500

Multiple Minnesota health insurance companies have launched websites that encourage consumers to post comments regarding their experiences with healthcare providers in the insurer’s networks. The sites include BlueCross BlueShield of Minnesota’s healthcarescoop.com, Medica’s mainstreetmedica.com and Health Partners and Preferred One. The ability to post comments is part of a statewide effort by Minnesota’s healthcare organizations to provide information to consumers of healthcare. The Minnesota Department of Health condones the action as a way for physicians to gauge patient satisfaction. An executive from BlueCross BlueShield Minnesota says that the decision to post consumer comments stemmed from prospective patients who wanted ratings and descriptions of actual patient experiences with network doctors.

HealthCare Survey --None--

Tue, 01 Jan 2008 00:00:00 -0500

Interests Survey --None--

Tue, 01 Jan 2008 00:00:00 -0500

Legal --None--

Tue, 01 Jan 2008 00:00:00 -0500

Willing To Relocate Survey --None--

Tue, 01 Jan 2008 00:00:00 -0500

Jan Newsletter --None--

Tue, 01 Jan 2008 00:00:00 -0500

Index --None--

Tue, 01 Jan 2008 00:00:00 -0500

Prices Spike in 2007 --Industry News--

Mon, 21 Jan 2008 00:00:00 -0500

Looking back from the new year, many analysts are now confirming that 2007 was in fact a year characterized by above-average prices for a wide variety of healthcare services. When compared with economic indicators for non healthcare-related goods, in particular, it appears that consumers paid substantially more for medical care. In relation to the Consumer Price Index (CPI), hospital prices increased by 8.3 percent from January to December 2007, compared with a CPI increase of 4.1 percent for non healthcare-related goods and services. Using the Producer Price Index (PPI) as an indicator, hospital prices rose 3.1 percent in the same time period. For individual physicians’ offices, prices rose 4.2 percent using the PPI, up from a 1.1 percent increase in 2006. Using the CPI, prices rose 4.1 percent, over twice as high as the 2006 CPI increase of 1.7 percent. According to Joseph Kowal, an economist at the Bureau of Labor Statistics, prices were “high no matter how you look at it for physicians.” Over the past calendar year, internal medicine prices rose by 11.1 percent, general family practices prices rose by 6.4 percent, and multispecialty practice offices increased by 7.4 percent. Unaffected by price spikes were obstetrics/gynecology, pediatrics, and general surgery. Given worries of an oncoming recession, analysts insist there is “no immediate cause for alarm,” as healthcare costs should stabilize over the next few years.

Quick Clinics and Health Kiosks Are Taking Off at Airports --Staffing & Recruitment--

Mon, 11 Feb 2008 00:00:00 -0500

Onsite medical clinics have recently been appearing in airports across the country in hopes of drawing travelers to receive small-scale medical care while waiting for their flights. Originally initiated to address medical issues of airport and airline employees, clinics and medical kiosks have recently been drawing in broader crowds of passengers and are providing them with flu shots, diagnostic testing, and medical identification. The University of Illinois at Chicago Medical Center has been conducting clinics at O’Hare International Airport since 1995. The clinics began issuing flu shots at a single kiosk and provided the majority of their services to busy airport and airline personnel. Recently, the medical kiosks have been utilized more readily by traveling passengers and have been placed throughout four terminals in the airport; the kiosks are now in the process of expanding their services year-round. Future airport clinics are set to include diagnostic blood testing services where patients can receive their test results once arriving at their destination via a secure website. The clinics are also aiming to provide patients with a health identification card listing the important details of their medical history.

The Profit Potential of Hospital Labs --Industry News--

Tue, 01 Jan 2008 00:00:00 -0500

Are hospital laboratories a “necessary evil” cost center for organizations, or do they hold the potential to actually increase hospital revenues and contribute greatly to the bottom line? An article in the January issue of HHN Magazine contends that the latter option is not only a possibility, but an easily attainable outcome. The article proposes that—since a hospital lab structure is typically 50% fixed-cost and 50% variable cost—a doubling of the amount of tests run in a lab can result in a cost reduction of 25% on all tests run. This increased workload results in increased revenues for the hospital, a greater utilization of already purchased facilities and equipment, and an overall increase in capital. The authors put forth the main criteria necessary to turn hospital labs into revenue generators: Control billing: Making sure the billing functions of the lab are up to date, efficient, and sufficiently supplied with capital to allow growth will ensure that the billing services department is fully capable of collecting fees from participating physicians as needed. Since the lab will be operating at a greater volume, leaving the increased billing needs up to the regular hospital billing department could introduce unneeded inefficiencies. Maximize advantages: Laboratory outreach on the part of a hospital puts it in direct competition with commercial labs. Hospitals must maximize their organizational advantages—staff doctors, community standing, quicker response times—to ensure competitiveness.

Medical Tourism Taking Flight? --Industry News--

Thu, 24 Jan 2008 00:00:00 -0500

Despite the potential appeal of receiving medical care at significantly discounted rates, a recent study titled “Health Care Benefits: Eligibility, Coverage and Exclusions,” found that only 11 percent of organizations surveyed include medical tourism as a benefit. The study, conducted by the International Foundation of Employee Benefit Plans, examined the benefits policies of a variety of US companies, industries, and regions. According to one observer, the difference in prices for procedures in the United States versus offshore facilities with strong healthcare credentials can be more than 50 percent. However, a number of obstacles stand in the way of medical tourism’s widespread adoption, primarily including the unwillingness of patients to leave the comfort of friends and relatives to undergo major medical procedures. Another potentially significant obstacle concerns insurance carriers. Current healthcare networks are unlikely ready to accommodate offshore medical care, and insurers are reluctant to be the first to move forward on this issue. Nevertheless, the study concludes that medical tourism as a healthcare benefit has strong potential in promoting the highest quality care at the best price, once “real and psychological” hurdles are cleared.

HHS’ New Year’s Resolutions --Industry News--

Mon, 21 Jan 2008 00:00:00 -0500

Coming into the final year of the Bush Presidency, there are many issues of concern to healthcare professionals in the following months. Topping the list of concerns is a comment by Health and Human Services Secretary Mike Leavitt that suggests the Medicare Advantage program, a proposal to increase Medicare payments to physicians, will most likely not come to fruition. President Bush promised that he would not levy a tobacco tax to pay for the Medicare Advantage program, and many are left wondering how Medicare physicians will be paid. “It’s really unlikely the Hill is going to accept the president’s budget if there’s deep cuts to hospitals,” argues Chip Kahn, president of the Federation of American Hospitals, but economic indicators suggest that there could be a growing gap for hospital funding in the near future. Should HHS not find a suitable arrangement in the next few months, Medicare physicians could feel the full brunt of a 10 percent reduction in physician funding that is scheduled for July 1 of this year, with the additional 5 percent cut taking place on January 1, 2009. The physician funding problem will not be easily fixed, and the Congressional Budget Office argues that a full overhaul of the existing scheme will cost the federal government upwards of $262 billion over the next 10 years, in addition to the $70 billion in higher costs for Medicare beneficiaries. All eyes are fixed on Congress’ actions over the next year, and healthcare professionals are awaiting the release of President Bush’s fiscal 2009 budget request for HHS, expected to come in early February.

Med Schools Adjusting to Millennial Students --Industry News--

Tue, 01 Jan 2008 00:00:00 -0500

A new generation of medical students is making its way into American medical schools and changing the status quo as they come. A recent article on the American Medical Association’s news page, amednews.com, explores the impact of the so-called “millennial generation”—young Americans born between the early 80s and the early 2000s—on medical education in this country. The primary effect of the Millennials has been a shift toward collaborative learning in medical education. Millennials are a tech-savvy and group-oriented generation and are more likely to embrace team-based learning. Consequently, schools are developing more collaboration-intensive structures for instruction. Students now frequently collaborate with older students and students from nursing and physical therapy fields. The result is a more interconnected generation of future doctors who are almost certain to have a transformative effect on American medicine in the years to come.

Are You Recruiting a Disruptive Doc? --Staffing & Recruitment--

Mon, 01 Oct 2007 00:00:00 -0400

Over the past few years, statistics have shown a stark increase in diagnoses of mental health problems among physicians, including psychopathology, personality disorders, and behavioral abnormalities. Since medical recruitment potentially samples a number of physicians suffering from mental illness, it is important to be able to distinguish traits in a physician’s behavior as potential disruptions to medical practice. In order to aid in trait identification, one psychologist who specializes in organizational behavior and healthcare consultation offers recruiters some warning signs to watch for when screening potential candidates for medical positions: Inappropriate Anger -How does the candidate speak to others? -Does he use intimidation or unnecessary sarcasm when conversing? -Does he criticize or scorn authority to whom he should be showing respect? Inappropriate Words/Actions -Does he use untoward racial, economic or socioeconomic comments? -Does he make sexual comments/innuendos or portray seductive or aggressive behavior? Inappropriate Response to Patient Needs and Staff Requests -Does the candidate respond to pages with respect and concern or with impatience and rigidity? -How does the candidate respond to changes in his schedule? -Is he able to readily adapt or does he show irritability when things do not go according to his plan? Overall Measure of Candidate’s Behavior -Pathological – Has the behavior surpassed the boundary of “normal”? -Persistent – Is there evidence that this behavior has happened frequently elsewhere? -Pervasive – Does the behavior carry across settings and with various types of people?

Job Sharing: Flexibility Has a Price --Staffing & Recruitment--

Fri, 18 Jan 2008 00:00:00 -0500

As a reaction against increasing time constraints for private practice physician offices, some doctors are turning towards job sharing models with varying levels of success. Instead of searching out part-time jobs, more and more doctors simply split their time in an office and on-call with another physician. Since the 2 doctors are effectively employed in the same position, there are many difficulties with this arrangement, though some have found all of the rewards of being a physician with the flexibility of part-time employment. In a successful example of job sharing, two female physicians in a private practice in South Carolina alternate three and four day workweeks, with each physician spending about 20 to 25 hours in the office. With 3 children each, this agreement allows them to spend more time with their families than a traditional practice. Likening job sharing to a marriage, Medical Economics recognizes that physicians must be in similar places in their lives, and have a lot in common professionally and personally. Doctors who are familiar with one another’s work and have similar management styles are the best candidates for job sharing, as both partners will be required to do the exact same work at different times throughout the week. There are some downsides to job sharing. Medical malpractice insurance policies are the same price as for full-time physicians, though job sharers only take in 50 percent salaries. Income is lowered considerably, and physicians with relatively fixed scheduling caps may have difficulty working extra hours to earn substantial funds beyond what covers overhead. Additionally, doctors with different expectations about what job sharing entails will most likely result in a failed business venture. The article warns of one sharing practice that failed when two doctors could not cooperate on a variety of simple organizational tactics. For doctors with the need to reduce their working schedules and a willing and agreeable partner, job sharing can be a unique way to continue practicing medicine with the flexibility of a much less demanding job.

How Doctors are Paid Now, and Why It Has to Change --Employment & Compensation--

Sat, 01 Dec 2007 00:00:00 -0500

Despite the growing popularity of pay-for-performance programs among health plans, most doctors are still paid on a fee-for-service basis. The American College of Physicians, along with other professional groups and health plans, has begun to criticize these payment practices, claiming that they devalue crucial services such as doctor-patient discussions, while over-rewarding expensive procedures and larger volumes. These groups also claim that fee-for-service plans are increasing pressure on primary care doctors to shift into specialty fields in search of higher pay. According to a 2007 survey conducted by the Medical Group Management Association, primary care physicians reported an average 4 percent increase in income while specialists saw a 6 percent rise on average. Some specialty fields have seen even larger increases, as infectious disease specialists experienced a 9 percent average rise, and pulmonary disease specialists reported an increase of more than 11 percent. Analysts warn that these incentive structures could cause a shortfall in primary care physicians in coming years. As a solution, the ACP is recommending a new compensation plan that would combine risk-adjusted capitation with pay-for-performance programs, along with fee schedules to ensure that doctors are still compensated for the volume of work they perform. With this in mind, WellPoint, Aetna, the Blue Cross & Blue Shield Association, Cigna, Humana, MVP Health Care, and UnitedHealthcare have joined the Patient-Centered Primary Care Collaborative in an attempt to advance this new physician compensation approach.

New County Program Reimburses South LA Doctors for Indigent Care --Employment & Compensation--

Tue, 01 Jan 2008 00:00:00 -0500

A new reimbursement program is now available from the Los Angeles County Department of Health Services for nine private hospitals affected by the closure of the Martin Luther King Jr.-Harbor Hospital. Under the PSIP-Impact Hospital Program, the county is paying 100% of Medicare fees for as many as six hospital days’ length of stay. This service is being provided to those patients who enter the surrounding private hospitals from the area previously served by the MLK hospital. The new program is simple for doctors as it requires most of the patient screening to be conducted by the hospitals. The hospital simply has to verify that the patient came from the geographic area relative to the MLK hospital and is a resident of Los Angeles County. The MLK-area hospitals received notice of the new program in November, and seven of the nine potential hospitals had already signed on by early December. Funds are readily available to physicians residing in the participating hospitals.

Oops, Did I Do That? --Employment & Compensation--

Fri, 01 Feb 2008 00:00:00 -0500

Can an unedited cover letter cost you a job? Could an innocuous comment knock you out of the running for a dream position? An article in the Winter 2008 issue of Unique Opportunities Magazine says yes. The most common mistakes candidates make in job searches are often the easiest to avoid. In the article, a professional recruiter for hospital organizations lays out what these mistakes are and how to avoid them: -Be careful with the send button. Electronic communication, while convenient, is also instant and permanent. It must be thoroughly edited and proofread before sending. Typos and unspecified letters are a definite turn-off for recruiters who are tired of reading badly edited cover letters. -Be polite. Much as it seems evident on its face, apparently it needs saying: do not threaten or otherwise be rude to recruiters or potential employers. Not only does it lessen one’s chances of getting that particular job, but one never knows when or where that recruiter may pop up again. -Money shouldn’t lead. Leading off recruitment letters with salary range restrictions reflects badly on the applicant. Money is important, of course, but such talk can always come later, once the applicant and recruiter have a better idea if the applicant is a fit for the job. -Be consistent. A candidate who constantly changes geographic, compensatory, or professional demands comes off as inconsistent and unreliable. Recruiters notice these things and do not remark kindly upon them. -Tailor a geographic target. The recruiter recommends keeping an open mind as to geography. Don’t just stick to one city and pursue a position there with blinders on. A fair look at surrounding areas may show you something you didn’t even know you wanted.

Smarter Scheduling Puts You In Control --Employment & Compensation--

Fri, 18 Jan 2008 00:00:00 -0500

How doctors schedule their patients’ appointments can make or break a steady flow into a private physician’s office, and Medical Economics analyzes 4 popular scheduling practices employed across the country. Dividing each hour into blocks of 15 or 30 minutes is the standard approach, though it fails to account for no-shows or patients arriving to the office late. With minimal flexibility, this strategy is most likely to lead to substantial backups throughout the day. More popularly, many offices schedule multiple patients for the same time and hope that within the given time frame, all patients can be treated. This approach, known as wave scheduling, works well in the case of a no-show or general tardiness, but problems arise when every patient shows up at the scheduled time. Medical Economics suggests using a modified wave schedule where two or three patients are front-loaded at the top of the hour while the remaining slots within the block are given to individual reliable patients. Open-access scheduling, where large numbers of slots are left open for same- or next-day appointments, is also an option. This allows doctors to treat patients more immediately, and works best when only a portion of the day, say 40 percent of the time slots, are left open for patients seeking immediate medical help. Clustered and group visits, where doctors can treat multiple patients with the same medical issues, can work, though there are significant privacy issues that need to be considered. The most successful practices employ some mix of these strategies, and the authors reiterate that there is not a turnkey solution that can work at all practices. Understanding what approaches work best for each individual practice is crucial, and having a qualified full-time scheduler who knows what works best is equally important.

Locum Tenens 101 --Employment & Compensation--

Tue, 15 Jan 2008 00:00:00 -0500

Currently seen as a sustainable career alternative to those in the medical field, locum tenens is becoming a readily accepted form of medical provision. In order to educate providers on how best to transition from traditional medical practice to locum tenens, experts in the field have outlined preparatory steps to make the transition easier. First, medical providers should seek out medical staffing agencies to determine what is expected of locum tenens candidates. Staffing agencies often require a full education and employment history, licensure verification, and a criminal and drug background check of potential candidates. They might also review medical malpractice claims and may require the candidate to complete a clinical skills assessment to determine clinical aptitude and competence in a given field. To complete the staffing registration process, most agencies require at least three professional references to verify clinical abilities and professionalism in medical practice. Experts recommend that candidates apply with more than one agency to increase options for medical placement. Upon being matched in a potential position, a locum tenens candidate should find out as much as possible about the location of the work to determine if the position is suitable. Information collected should include the name and location of the position, shift schedules, patient demographics, and housing accommodations to name a few. Lastly, prior to beginning a career in locum tenens, it is recommended that candidates speak to other locum tenens providers who have had extensive practice in the field. By learning about locum tenens experiences first-hand, future candidates can make an informed decision as to whether or not this is a suitable career.

Research in Hospice Possible, Even Helpful --Medical - Legal Matters--

Mon, 04 Feb 2008 00:00:00 -0500

Is it ethical to conduct clinical trials with hospice patients? The increasingly data-driven nature of medicine brings this question to the forefront, and a recent article on the American Medical Association’s news site contends that such research can have a beneficial effect while maintaining ethical standards. The article puts forth that knowing what constitutes the “best possible care”—the creed and purpose of hospice care—is not in fact possible without research and comparison of results. For example, research into cardiac disease yielded the discovery of beta blockers as an effective method of treatment. Furthermore, the authors contend that hospice patients aren’t universally non-functional and helpless, as they are often perceived to be. Many are cognizant and capable of making treatment decisions on their own. Proper and full education of hospice patients as to their treatment options and possibilities for research participation is, according to the article, in full keeping with established ethical norms. The authors propose novel rearrangements of placebo trials in order to minimize any ethical concerns that can arise from the use of placebos, such as a case wherein patients in one arm of the research receive the shorter-acting morphine solution plus a placebo in pill form, while patients in the other arm get the longer-acting pill plus a placebo in solution form. This way, participants and providers are adequately blinded to the intervention, ensuring that the data obtained is unbiased and applicable to future patients. Finally, the article contends that the ethical hurdles of hospice research are not insurmountable. Well-designed trials can provide valuable research data while maintaining the highest ethical standards and upholding patient dignity.

Your Risks When Practicing Telemedicine --Medical - Legal Matters--

Fri, 18 Jan 2008 00:00:00 -0500

Given growing trends in telemedicine, Medical Economics provides several suggestions for physicians looking to protect themselves from problems with licensure, conflicting state laws, and malpractice insurance coverage. Since telemedical doctors usually evaluate patients across state lines, there are many legal issues at stake. While some states offer limited licensing for physicians practicing telemedicine, it may be necessary to gain licensure for every state in which potential patients live. Additionally, if a patient living in a different state files suit, the laws of that particular state will most often apply. Doctors should familiarize themselves with malpractice laws in other states and make certain that their malpractice insurance covers operations in other states. Standards of care are becoming increasingly uniform, but doctors still need to recognize the potential problems that interstate practice can cause. There are as yet too few cases of major telemedical disasters to establish standardized practices at the national level, and there is very little evidence of doctors practicing telemedicine internationally. Given the novelty of the industry, doctors looking to practice medicine remotely need to exercise legal caution whenever possible.

Dispatch from the Pharmasphere: An Industry’s Fault Lines on Display --Medical - Legal Matters--

Fri, 01 Feb 2008 00:00:00 -0500

An Annals of Emergency Medicine correspondent reports on business practices at global pharmaceutical companies, noting that big pharmas keep a detailed database of doctors’ habits. Information kept on MDs includes how they prescribe (does the doctor have a “heavy pen”?), what they publish (are they a “Big Kahuna” or an “up-and-comer”?), and even how they feel about pharmaceuticals (do they have a sense of “industry affinity”?). Accordingly, this information is used to find doctors who are the best candidates for distribution of new prescription drugs and treatments. The report underscores a growing concern that pharmaceutical companies see doctors as sales agents, and pharma-friendly doctors see these companies as “The Bank.” Complaints about this data-gathering practice range from philosophical to legal, where significant privacy laws regarding the distribution of personal information differ across various jurisdictions. Yet, the report argues, there is little reason to indicate that pharmaceutical companies are as unethical and greedy as they may initially appear. Evidence from a recent conference of KOLs (“Key Opinion Leaders,” or influential doctors who negotiate with pharmaceutical companies regarding appropriate practice) confirms good faith that pharmaceutical representatives are doing their best to foster responsible communication with doctors. Whether the relationships between doctors and big pharmas are ultimately deleterious to public welfare remains to be seen, and time will tell if practices like MD habit databases are healthy business practices.

Take Care When Firing a Patient --Medical - Legal Matters--

Mon, 04 Feb 2008 00:00:00 -0500

While there are a number of reasons why a physician would be justified in terminating a physician-patient relationship, including a failure to pay bills, continual rude disruptive, or threatening behavior, patient dissatisfaction with care received, or a patient’s requirement of specialized services a physician cannot provide, special care should be taken in acting on this decision. Steven M. Harris, a partner at McDonald Hopkins, a firm concentrating on healthcare law, suggests that the physician should handle the termination like any other contractual relationship, by drafting a letter to the patient that specifically details why the relationship has been terminated. Additionally, it is prudent for the physician to consult an attorney, to avoid any possible legal issues in the termination process. In general, Harris advises the physician to: -Clearly communicate his or her decision, in as compassionate and supportive a manner as possible. -Offer assistance and provide the patient a reasonable timeframe in which to select another physician. -If medical care is needed during the patient’s search for a new physician, care should be continued by the original physician in the interim. -Notify the patient’s other physicians of his or her change in care provider. -Carefully document all related proceedings, including detailed records of discussions with the patient. Above all, the physician must be sure to always act in the best interest of the patient.

Hospital Emergency On-Call Coverage: Is There a Doctor in the House? --Medical Specialty Focus--

Thu, 01 Nov 2007 00:00:00 -0400

Community hospitals are finding it difficult to obtain on-call specialist physicians for 24-hour patient care, as a recent study notes that 73% of emergency departments in the U.S. report insufficient on-call coverage. Factors contributing to the reluctance of physicians to provide on-call services include decreased dependence on hospital admitting privileges, payment for urgent care treatment, and increased medical liability. Although hospitals have adapted strategies to secure on-call coverage, many continue to toil with insufficient coverage that threatens patient care and may increase healthcare costs overall. In the past, doctors agreed to provide on-call care in exchange for hospital admittance privileges. More recently, physicians are moving away from practice in hospital settings or shifting to specialty hospitals that don’t have emergency departments. Payment for medical care also proves to be a limiting factor, as physicians note that the payment they receive for on-call care is often inadequate, and the opportunity cost of leaving their private practice to attend the hospital is great. Furthermore, cases seen in the emergency department are often large and more challenging, which translates into a greater risk for those physicians who provide care, to say nothing of the quality of life issues involved with being on-call. To combat this deficit, hospitals are engaging in numerous strategies, including weekly or daily payment for on-call coverage, payment per-patient-seen while on-call, and more direct employment of specialty physicians by hospitals.

Outcomes of Care by Hospitalists, General Internists, and Family Physicians --Medical Specialty Focus--

Thu, 20 Dec 2007 00:00:00 -0500

This 2007 study compares the efficiency of the hospitalist model in patient care and health outcomes to healthcare provided by general internists and family physicians. The study found that after controlling for numerous patient, hospital, and physician-related factors, patients treated by hospitalists had a shorter length of stay and lower healthcare costs at the time of visit while exhibiting similar death rates and readmission rates to those patients treated by the other groups. Patients included in this retrospective cohort study were diagnosed with one of seven common illnesses (pneumonia, acute exacerbation of chronic obstructive pulmonary disease, ischemic stroke, chest pain, acute myocardial infarction, heart failure or urinary tract infection). Primary analyses showed that the majority of patients (43%) in the study were cared for by general internists, 32% received care from hospitalists, and the remaining 25% received care from family practitioners. The results of the multivariable analyses, after controlling for factors including the patient’s principal diagnosis, patient demographic characteristics, hospital characteristics, physician case volume and clustering of patients with physicians and of physicians with hospitals, show that patients cared for by hospitalists had a 0.4-day shorter length of stay (p<0.001) and costs that were $268 lower (p=0.02) than those patients treated by internists and family physicians.

The Palliative Care Initiative --Medical Specialty Focus--

Mon, 01 Oct 2007 00:00:00 -0400

With over 90 million people living in the US with chronic illness, many Americans will need some form of palliative care in the near future, but increasing healthcare costs translate into a huge burden for those requiring this form of care. Statistics show that approximately 75% of the nation’s healthcare spending goes to care for those with chronic illness. While many of those receiving palliative care are older and receive some coverage under Medicare, many out of pocket costs weigh significantly on individuals and families of chronic disease patients. For the incredible costs that patients receiving palliative care incur, the improvements in their health and overall quality of life are not always guaranteed. A new model of palliative care has now become necessary to aid in cost control and to solidify the promise of comfort and care with chronic disease. There has never been a better time to strengthen the use of palliative care within hospitals. Use of this care within hospitals has been shown to decrease costs by $6,580 per patient. It can also be performed by a multidisciplinary team that can work together to improve patient health, overall quality of life, control of symptoms, and direct management of pain.

Major Trends Affecting Hospital Payment --Payer & Reimbursement Issues--

Tue, 01 Jan 2008 00:00:00 -0500

As healthcare spending continues to increase, hospitals need to act more efficiently in key areas in order to maintain sustainable profit margins. Payment policing efforts will be very important, as hospitals are currently seeing 8 to 14 percent of revenues go uncollected. Hospitals should install monitoring systems to find out how and why underpayments are occurring and increase communication with payers like Medicaid, Medicare, or PPOs. Additionally, hospitals should analyze contract performance through modeling systems that predict how profitable each contract will ultimately be. Payers are increasing pressure to shift volume and cost risk to hospitals. To prevent hospitals from having to accept lower payments, hospitals should understand their preferred payment methods as well as what sorts of risks are acceptable to assume. By shifting risk back to providers as much as possible, variability of cost and volume will stabilize and hospitals will receive higher payments. As patients begin gaining more leverage through consumer-driven health plans, hospitals should establish benchmarks to ensure that their level of service is as attractive as possible for patients shopping for medical services in an open market. As health plans are consolidated in the name of efficiency, hospitals should strive to make sure that these efficiencies are not reached at the hospital's expense. Healthcare executives should strive to provide the highest level of care possible while remaining cautious about accepting too many financial concessions in negotiations with payers.

How to Collect From Patients Without Scaring them Away --Payer & Reimbursement Issues--

Fri, 15 Feb 2008 00:00:00 -0500

Realizing that missed payments can be a major source of discomfort to physicians’ offices, Medical Economics makes recommendations for dealing with irresponsible patients. Rather than treating all patients as freeloaders, doctors should assume that everyone wishes to pay their bills in good faith. Oftentimes patients do not realize that they are obligated to pay for every visit, or that certain procedures are not covered by their insurance. Educational tactics that gently remind patients of their obligation to pay for services can be very helpful as they do not antagonize passive individuals. When involving third-party collection agencies or reporting patients to a credit bureau, doctors should be certain that all other means of asking for payment have been utilized. Using an overly abusive collection agency that threatens patients can generate much unneeded negative publicity, and ruining a patient's credit by involving a credit bureau can have a ripple effect among the local community. In rural areas, doctors will find that losing long-term customers from word-of-mouth smear campaigns is much more financially troublesome than losing a payment or two from individual patients. Physicians must be firm in requiring timely payment, so as not to seem a pushover, but treating all patients with respect in regards to financial issues will ensure better long-term success at a private practice.

It’s Everywhere --Payer & Reimbursement Issues--

Mon, 24 Dec 2007 00:00:00 -0500

A recent survey conducted by the Leapfrog Group and Med-Vantage has shown that Pay-for-Performance (P4P) is widely utilized among hospitals and physician groups nationwide, and the programs are also increasing in number to include a broader base of physician specialties. Yet while its practice is becoming increasingly apparent, the overall effectiveness of P4P is much more difficult to measure. In an attempt to evaluate P4P practice, Med-Vantage surveyed 75 P4P sponsors including government agencies, health plans, and purchaser coalitions. Seventy-five percent of survey respondents reported that P4P helped to improve health care quality - including clinical health outcomes and overall patient satisfaction – and helped to decrease medical errors. Almost one third of respondents reported that cost performance improved upon initiation of P4P. The majority of respondents to the survey were physician P4P groups, which outnumbered hospital-based programs 4 to 1. Almost half of respondents said that their P4P programs were between one and two years old.

Simulated Data Study May Boost Hospitals’ Bottom Line --Payer & Reimbursement Issues--

Fri, 04 Jan 2008 00:00:00 -0500

The Methodist Le Bonheur Healthcare Research Center in conjunction with the University of Memphis Center for Healthcare Technology has recently developed an innovative approach to finding ways to boost nurse capacity and efficiency. Data farming is a technological way of examining what nurses do in one day in order to determine the best way to utilize them as resources within the hospital setting. First developed by the Marine Warfighting Laboratory for use in improving the understanding of combat situations, data farming uses computer simulations to analyze nurse workflow to find ways to increase nursing time at a patient’s bedside. Not to be confused with data mining, which uses de-identified real-patient data to study patterns in marketing, data farming essentially creates data to generate scenarios within a group of imaginary patients. Data farming can also find ways to improve physical environments in nursing areas. By developing ways to group nurses together and requiring them to do less walking between patients, nurses can perform better and more efficiently overall. Preliminary data from this study has shown the potential of data farming to decrease patient hospital stays, which can reduce healthcare costs for the hospital’s bottom line. Decreased patient stays may help improve nursing work capacity which, overall, may also aid in the retention of nursing staff and a reduction in nurse-to-patient ratios.

Aetna to Stop Paying for Anesthesiologists During Colonoscopies --Payer & Reimbursement Issues--

Mon, 04 Feb 2008 00:00:00 -0500

At a meeting in January between Aetna insurance representatives and one of Atlanta’s largest gastroenterology groups, fifty doctors gave out letters of resignation to the company and threatened to pull out of the insurer’s network in protest of a change in the company’s policy regarding anesthetizing patients during colonoscopy procedures. Beginning in April, the company is set to end its coverage of anesthetization of patients during the invasive procedure. Physicians of the Atlanta-based gastroenterology group are asking Aetna to rethink their decision since it will most likely discourage patients from undergoing the important cancer-screening procedure. Aetna is following suit in withdrawing coverage of the colonoscopy procedure after Humana and Wellpoint made similar change in their coverage within the past two years.

Study Supports Periodic Re-Certification For Doctors --Credentialing, Licensure, Quality Management--

Mon, 21 Jan 2008 00:00:00 -0500

In 2006, specialty medical boards began requiring periodic re-certification for physicians, though scientific justification for the decision was at the time lacking. A new study led by Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston found a positive correlation between recent physician re-certification and proper medical treatment for hypertension patients. The study’s results, to be published in the February issue of Circulation, supports current mandatory re-certification practices, according to Turchin and his colleagues. For patients admitted to hospitals for hypertension, increased intensity of care is indicative of higher quality care. Looking at 54,000 medical visits from 2000 to 2005 where patients showed signs of high blood pressure, Turchin compared changes in treatment intensity with the most recent time doctors were re-certified. The highest frequency of treatment intensification occurred where physicians were certified within one year of the hospital visit. For every decade since the most recent board certification, treatment intensity was diminished by roughly 21 percent, with the worst care given by the six physicians who were last certified over thirty years ago. The study gives credibility to specialty boards’ decision to require re-certification, and Turchin hopes the research will be used to increase educational efforts to “help improve quality of care delivered by physicians.”

Microsoft, Mayo Clinics join to empower patients, protect privacy --Credentialing, Licensure, Quality Management--

Fri, 25 Jan 2008 00:00:00 -0500

Microsoft and Rochester, Minnesota's Mayo Clinic recently announced a partnership that will focus on increasing patient-to-physician dialogue for individuals using the Mayo Clinic Health Solutions. The partnership will focus on providing new technology that enables patients to have more control over decisions affecting their health. Using Microsoft's HealthVault program, the partnership will build "solutions that are dynamic, secure and focused on the needs of the user, in order to effectively improve health and well-being," according to Peter Neupert, corporate vice president of Microsoft Health Solutions Group. Protecting patients' personal information has been a major focus of the program, and a spokesperson for the Coalition for Patient Privacy has stated that the HealthVault technology is the first system to pass the coalition’s rigorous privacy standards. Further details of this project are expected to be announced in the near future.

Engage Employees to Improve Staff and Patient Satisfaction --Credentialing, Licensure, Quality Management--

Tue, 01 Jan 2008 00:00:00 -0500

In hospitals, there is a well demonstrated correlation between patient satisfaction and employee satisfaction. Creating a hospital that provides the highest level of service for patients also means that employees should be given the best possible environment in which to work. According to a study by Press Ganey, the biggest cause for employee dissatisfaction is lack of participation in decision-making processes involving hospital organization or improving customer service. Strategic management initiatives that involve staff members in decision-making will benefit the hospital as a whole and in turn increase patient satisfaction levels. Exemplifying the idea of employee participation, at King's Daughters Medical Center (KDMC) in Ashland, Kentucky, the hospital management created a program to generate ideas for improving hospital operations. All employees are encouraged to submit proposals for improving customer service. KDMC team leaders vote on which initiatives to implement, and winners are given an unbudgeted capital item. Other management techniques include sponsoring a Customer Satisfaction Innovations Fair where employees are shown new opportunities for improving customer service. Involving employees in the management of a hospital can be a useful way of improving customer service all around. Hospital executives should continue to monitor patient satisfaction levels, making this information available to all employees. Further, rewarding employees who show a unique commitment to customer service will ensure that staff and management are working together towards an overall improvement of hospital operations.

Mapping Opens Hospitals’ Eyes to Patient Experience --Credentialing, Licensure, Quality Management--

Fri, 01 Feb 2008 00:00:00 -0500

A growing number of hospitals are beginning to employ “experience mapping” techniques to gain better insight into their patients’ expectations and experiences. Such processes, which combine in-depth patient interviews with general research on patient needs, are proving useful when undertaking major planning initiatives such as designing a new facility, selecting a new information technology strategy, or embarking on a rebranding campaign. Hospitals utilizing experience mapping techniques typically start by establishing a team of internal stakeholders responsible for delivering care in a specific project area. The team works with researchers to draft an “experience map” to serve as a guide for patient interviews. They next employ a variety of interview methods, including one-on-one settings, small groups, or patient intercept techniques. In small group or one-on-one interviews, patients are asked to recall their first experience with the hospital and then compare it to later experiences. When conducting a patient intercept, researchers follow patients through their entire hospital visit, from admittance to discharge. As a final step, team members and other hospital staff examine interview transcripts and research and try to devise ways to translate what they have learned into practice. Results from such projects have ranged from more patient-friendly online services to ads incorporating physician and staff photos to humanize care as part of a rebranding initiative.

Healthcare Providers Will Broaden Adoption of Clinical Technology in 2008 --Healthcare Technology--

Wed, 23 Jan 2008 00:00:00 -0500

According to an annual study published by the Gallantry Group, 2008 should see major increases in available clinical technology at healthcare facilities of all sizes. Nearly half of healthcare providers will spend upwards of 40 percent of their existing technology budgets to increase current offerings, and by the end of 2008, more than 80 percent of healthcare facilities should have invested in the following technologies: -Digital medical imaging -Medication management/e-prescribing -RIFD patient identification/drug distribution -EMR/EHR -Computerized physician order entry -Mobile applications (e.g. charge capture, rounding, prescriptions) -Patient documentation -Patient care planning solutions The report surveyed facilities of all sizes, from 150 beds to over 1,000 beds, including both public and private hospitals.

California Could Be the Next Health IT Model, Medicare Officials Say --Healthcare Technology--

Thu, 10 Jan 2008 00:00:00 -0500

A recent meeting of California healthcare officials brought together members of various sectors of healthcare and health technology to discuss the state’s standing amidst the US Healthcare IT model. Currently, California leads the race in utilizing healthcare technology in certain large medical practices. Studies by the California HealthCare Foundation have shown that 37% of Californian practitioners utilize electronic health records compared to 28% of physicians within the greater US. These physicians in California, however, often work for large practices or integrated health systems. Doctors in small practices in California accounted for only 25% of those using EHRs, while 13% of Californian providers in solo practices and 3% in community clinics use EHRs. As one attendee noted, the costs of supporting EHR are great, and currently no such funding system exists to support the practices that need it most, namely small clinics and private practices. Currently, preliminary data is being collected through a pilot program conducted in Arkansas, California, Massachusetts, and Utah in which physicians at small clinics and solo practices providing care for chronically-ill Medicare beneficiaries have been incentivized to report performance data through an electronic system. Results from the study are due out in six to nine months.

How to Make the New Doctor-Patient Relationship Work --Healthcare Technology--

Fri, 01 Feb 2008 00:00:00 -0500

With an increase in the use of internet health resources over the past few decades, the dynamic relationship between the physician and the patient is rapidly changing. While the doctor once provided paternalistic caregiving to his passive patient, the patient is now taking a proactive approach to his own health. A 2007 survey found a 37% increase in the number of Americans who had searched for health information online from the previous year. While the vast amount of information readily available can prove to be useful at times, it can also complicate the relationship between the doctor and patient. Difficulties arise because many of the available sources are either inaccurate, out-of-date, or provide information in the context of selling a commercial product. Seeking and obtaining false or misleading health information on the web can cause patient anxiety, which can oftentimes lead to a patient questioning his doctor’s orders. Outside of these potential drawbacks, internet health searches can be beneficial for certain health information-seeking populations. Residents and doctors can easily utilize websites maintained by medical schools, professional medical organizations, and federal government organizations. The web can also provide physicians with medical information that is not available elsewhere, including newly released studies and up-to-date information, and resourceful physicians may even use the internet to find ways to better engage their patients in a dialogue on health.

Insurers’ Online Forums Invite Patients to Vent --Healthcare Technology--

Mon, 28 Jan 2008 00:00:00 -0500

The internet has always been an open forum for patients to anonymously complain about poor medical care, though a new forum is raising doctors’ eyebrows. A website that debuted in November 2007, The Healthcare Scoop, is run by Blue Cross Blue Shield of Minnesota and asks patients to openly discuss the quality of care they recently received. Physicians are assigned a score that is used to evaluate quality at practices across the country. Many doctors are concerned about The Healthcare Scoop and argue that this quality-control practice is counterproductive. “It is extremely difficult whether patient dissatisfaction, resulting from denied or delayed services, or a failure to obtain a certain prescription, is due to the decision of the physician or the demands and restrictions of the health insurer,” says Edward L. Langston, MD, chair of the AMA Board of Trustees. Anonymously pointing fingers at doctors in such a way does little to encourage better treatment, doctors argue. Further, physicians have no way of responding to comments on the websites and fear that such modes of communication only create barriers between patients and physicians Blue Cross Blue Shield emphasizes that consumer ratings will not affect physician reimbursements and notes that positive comments outnumbered negative ones four to one. A similar site was launched by WellPoint on January 8 of this year, basing its physician grading on the Zagat restaurant ratings scheme.

California Docs Participate in Remote Monitoring Program for Diabetes --Healthcare Technology--

Fri, 15 Feb 2008 00:00:00 -0500

Physicians in Southern California are participating in a trial run of XTend Medical Corporation’s Medical Disease Management Program, designed to remotely monitor 500 diabetes patients. Utilizing an Eocene transmitter, patients take their glucose readings and transmit the results from their homes. The readings are sent as encrypted data to a central server for physician review. Physicians may then reply with information regarding adjustments in medication, compliance, or follow-up visits for the patients. This new program will allow physicians to closely monitor their patients from their offices while minimizing disruption of their patients’ daily lives. With continuous monitoring technology, XTend Medical believes that physicians will be able to reduce the likelihood of complications such as diabetic shock or hospitalization. The company reports that it is ready to implement the system nationwide.

Understanding Residents' Expectations --None--

Wed, 20 Feb 2008 00:00:00 -0500

survey residents results --None--

Mon, 04 Feb 2008 00:00:00 -0500

no summary

Many U.S. Consumers Want Major Changes in Health Care Design, Delivery --Industry News--

Tue, 26 Feb 2008 00:00:00 -0500

In a poll of over 3,000 Americans between ages 18 and 75, the consulting firm Deloitte Touche Tohmatsu gathered information on public attitudes towards healthcare. Financial concerns top the list of important issues, as 93 percent of consumers claim they are unprepared for future health care costs. 84 percent prefer generic prescription drugs over name brands, and 39 percent say they would travel abroad for comparable treatments in order to cut fees in half. 16 percent have already used a walk-in or retail clinic, and 34 percent said that they would. Increasing online access to healthcare information is another major trend in this year’s survey, with over 60 percent of respondents saying they want to be able to retrieve their medical records and test results online. A further 25 percent would be willing to pay a premium for these services. For the upcoming presidential election, 79 percent of respondents believe health care will be important, and 46 percent place it in their top 3 voting issues. On the question of increasing taxes to help the uninsured, 29 percent would support an increase, and 37 percent would be willing to “consider” a tax increase. Sixty-six percent are either strongly in support of or lean towards state-mandated health coverage. Health care still remains enigmatic to many; only 52 percent claim to understand their health plans, and just 25 percent of those surveyed keep a personal health record.

Who Really Pays for Health Care? --Industry News--

Wed, 05 Mar 2008 00:00:00 -0500

A commentary in JAMA by Drs. Ezekiel J. Emanuel and Victor R. Fuchs attacks the notion that healthcare coverage in the United States is a “shared responsibility.” In actuality, the commentators argue, healthcare premiums are paid for by individual workers in both public and private healthcare schemes. The authors point out that when adjusting for inflation over the last 30 years, though healthcare premiums have increased by 300 percent and corporate profits have increased by 150 to 200 percent, employee wages have only increased by 4 percent. Additional studies that further drive home the point show that a 10 percent increase in state health insurance premiums resulted in a 2.3 percent decline in employee wages. Though employers pay the premiums directly to providers, the actual costs are passed along to employees through reduced wages and consumers through increased prices. The same can be said for government healthcare programs that substantially increase taxes as state and federal programs increase their scope. According to Emanuel and Fuchs, dispelling the rumor that ordinary workers and citizens do not pay the full cost of healthcare coverage is crucial for reforming America’s healthcare system in a responsible manner. As employees begin to understand that they are already paying for their own coverage, they will be more likely to abandon their reliance on a system where employers supposedly foot the burden of premiums.

US Healthcare Spending to Double by 2017, Report Predicts --Industry News--

Tue, 26 Feb 2008 00:00:00 -0500

Already high numbers for healthcare spending in the US could double within 10 years, according to the Center for Medicare and Medicaid Services. The new government report follows a January 2008 report that revealed an increase in healthcare spending to 2.1 trillion dollars in 2006, a figure that represented 16% of Gross Domestic Product. The new report predicts a major shift in healthcare spending from the private sector to the public sector as the costs of maintaining the Baby Boom generation increasingly fall to the government. The increase in healthcare spending, coupled with the economic downturn widely forecast, is likely then to increase healthcare spending to 20% of GDP by 2017. While private spending is expected to drop from 6.6% of GDP in 2009 to 5.9% in 2017, Medicare is expected to balloon to $884 billion by that time. Prescription drug spending is expected to more than double in the same time span, reaching $515.7 billion in 2017.

Hospital’s Accounting is Under Fire by a Union --Industry News--

Wed, 20 Feb 2008 00:00:00 -0500

In an encounter that could have far-reaching consequences for hospitals around the country, a powerful labor union is pressuring a Boston hospital to modify its accounting procedures. The outcome of the confrontation could have an effect on non-profit hospitals and other organizations everywhere. Beth Israel Deaconess Medical Center, a Boston hospital, included the bad debt the hospital had incurred in its calculation of its 2005 and 2006 financial reports. Some $11 million of bad debt was included in the hospitals tally of its 2005 charitable care, raising the total value attributed to charitable care to $67.6 million. This figure is disputed by the 1.9 million member strong Service Employees International Union (SEIU), which is engaged in a nationwide reform movement. The SEIU contends that the debt write-off is in conflict with the accords of the Sarbannes-Oxley regulations, enacted after the Enron scandal to govern the accounting conduct of for-profit institutions. The IRS has made clear that such debt cannot be ascribed to charitable care, but that decision came after the filings in question and is not retroactive in nature. The matter is currently under evaluation by all involved parties and—though the hospital contends that there is no legal standing for the union’s objection—shows no signs of a quick resolution.

Doctor Shortage Impacts Rural Areas --Industry News--

Tue, 26 Feb 2008 00:00:00 -0500

Medical school enrollment caps in the 1980s and 1990s are the root cause of the shortage of surgeons and primary care physicians nationwide. So says an article in the Reno Gazette-Journal, and the effects of these decisions are said to be especially hard felt in rural areas. With the expectation that Managed Care would result in a glut of doctors, medical schools implemented caps on enrollments in the 1980s. These caps on enrollment numbers held steady throughout the next two decades, even though the American population increased by 70 million from 1980 to 2005. Since 2005, medical schools have realized the mistake and taken measures to try to alleviate the coming shortage by allowing more students. This resulted in a nearly 10% increase in enrollments last year over the levels of 2002, but the shortage is still expected to impact American healthcare, with the nationwide shortage being estimated at anywhere between 55,000 and 191,000 doctors by 2020. This shortage will be especially hard hitting for rural areas, which have a greater need for primary care physicians while at the same time having a harder time attracting physicians. In addition to the general shortage, primary care physicians are in shorter supply, as debt-laden students increasingly take positions in subspecialties that are more lucrative.

Foundations to Strengthen State Health Care Reform Advocacy --Industry News--

Wed, 06 Feb 2008 00:00:00 -0500

Several U.S. states will reform their health systems thanks to two large donations from the Robert Wood Johnson Foundation and the David and Lucile Packard Foundation. The Finish Line Project, funded by the Packard Foundation, will provide $15 million to organizations in Arkansas, Colorado, Iowa, Ohio, Rhode Island, Texas, Washington, and California to increase coverage for children. In a partnership with The Center for Children and Families at Georgetown University’s Health Policy Institute, the Packard Foundation will provide grants over the next 5 years for children’s health advocacy groups. Consumer Voices for Coverage, a $15 million 3-year program sponsored by the Robert Wood Johnson Foundation, will give money to selected comprehensive consumer health advocacy groups in California, Colorado, Illinois, Maine, Maryland, Minnesota, New Jersey, New York, Ohio, Oregon, Pennsylvania, and Washington. Both projects are expected to provide considerable strength to existing health reforms in the participating states. Organizations in California, Colorado, Ohio, and Washington will receive funding from both foundations.

Influx of Medical Students Creates Concern --Industry News--

Tue, 01 Jan 2008 00:00:00 -0500

An increase in medical students across the country necessitates equivalent expansion in resident training programs, according to an article in the winter issue of the Journal of the Association of Staff Physician Recruiters. A record number of students enrolled at medical schools in the fall of 2007, representing an 8% increase from 2002 to a total level of 17,800. This is largely in response to the American Association of Medical Colleges’ call to increase class size by one-third by 2015 to head off the coming shortage of doctors. This increase, though, will run into problems as these students encounter obstacles to placement in residency positions. This is because the residency programs in this country depend on federal funding through Medicare, which has remained stagnant. State funding is likely to alleviate some of the problem, but the author recommends that residency programs find some way of securing funding so that they can admit more students and avoid a bottleneck in the American residency system, which will only exacerbate the coming shortage situation.

Financial Support of Continuing Medical Education --Industry News--

Wed, 05 Mar 2008 00:00:00 -0500

Continuing Medical Education (CME) relies on funding, especially from commercial sources, which opens the door to dangerous conflicts-of-interest. In 2006, 75.8% of CME funding for publishing and education companies and 61.8% of CME funding for medical schools came from commercial support. In spite of measures in place to prevent conflicts-of-interest, some CME providers have a dangerously close relationship with the commercial industry, and companies often use CME to promote drugs through measures such as discussion of off-label uses. In April 2007, the Senate Finance Committee determined that pharmaceutical companies would only be providing CME funding in order to receive increased sales. Because drug companies typically fund CME proposals that involve conditions for which the company’s products are used, the committee argued that there could be implicit agreements between CME providers and pharmaceutical companies to promote certain products in spite of restrictions. Some measures to increase integrity of CME have already been taken. In August, 2007, the Accreditation Council for Continuing Medical Education (ACCME) definition of commercial interest changed to include some medical education and communication companies that have accredited CME units and also promote pharmaceutical companies. Those CME units must become distinct companies by 2009 to continue receiving accreditation. In addition, all CME providers must report relevant financial relationships and resolve conflicts of interest before any educational activity occurs. In spite of those restrictions, however, there is still a danger for abuse. Some have suggested that additional measures be put into place such as separating grant departments in commercial companies from marketing departments and creating criteria for grants. Many companies have voluntarily adopted these and other measures to maintain integrity, but even the value of these self-imposed measures is unknown. Other recommended policy changes to control industry funding of CME include banning or limiting any direct or indirect commercial support. These measures would require some CME providers to restructure or go out of business and would place more control of the CME industry back into the hands of medical professionals.

Retained Physician Search: Partnering for Results --Staffing & Recruitment--

Tue, 29 Jan 2008 00:00:00 -0500

As an alternative to contingency placement, where open positions for physicians are filled by candidates actively seeking a new job, many practices hire consultants who entice physicians to leave their existing posts in favor of better opportunities. The process, known as a retained physician search, finds candidates best suited to the new opening regardless of whether they are currently actively seeking alternative employment. A retained physician search can be quite expensive, but the payoffs generally outweigh the costs. Factors that influence the price for a retained physician search include the supply and demand of each specialist, the practice location, the scope of the sourcing strategy, the timeframe for filling the position, time spent on recruitment, the cost of bringing a potential physician to visit the practice, and any relocation reimbursements for the physician and the physician’s spouse. Despite these costs, a retained physician search usually finds the best candidate for a position through targeted recruitment (as opposed to contingency placement, which is primarily geared toward marketing physicians who are actively job hunting), and statistics show that physicians acquired in this manner stay in their new position for longer than 3 years over 85 percent of the time.

Growth Through Physicians --Staffing & Recruitment--

Fri, 01 Feb 2008 00:00:00 -0500

Physicians’ reimbursements are increasing at 2 to 3 percent annually, while the prices of nurse assistance and drug products are increasing at 5 to 6 percent annually. To best deal with rising costs, hospitals should focus on growing physicians’ businesses, increasing their skills, and maximizing patients’ loyalties. Healthcare Strategy Group asks seven questions that can help bring about hospital growth: -Can the hospital increase patient volume for physicians through “same store sales?” By establishing a hospital brand, physicians could refer patients to one another as a way of keeping patients coming to the same hospital for all of their needs. -Can the hospital increase geographic reach? By expanding geographically through marketing campaigns and referrals from existing PCPs, hospitals could increase the number of patients who turn to them for care. -Is the primary care base adequate? By understanding how many PCPs versus specialists are needed for everyday operations, hospitals could better plan how to increase hospital traffic through referrals. -Can the hospital increase rates? If a hospital garners enough market power through consolidations and brand strength, it can demand higher rates for services. -Does the hospital offer the most profitable services? Understanding which services produce the most profits is crucial for deciding what offerings a hospital could begin offering to patients. -Are there enough physicians in areas targeted for growth? Hospitals should assess whether they have adequate staff and physician levels for each area where they are considering expanding. If there are too many gaps or recruiting new physicians is difficult, the hospital may want to reevaluate its priorities. -Is there a retail medicine strategy? Hospitals should evaluate whether providing more expensive offerings, typically not covered by insurance, is worthwhile. Ultimately, the ability to offer all available services to patients, regardless of cost, is crucial to strong, forward growth.

Creating a Sustainable Physician Strategy --Staffing & Recruitment--

Tue, 01 Jan 2008 00:00:00 -0500

Due to an impending shortage of physicians (particularly gerontologists, oncologists, PCPs, neurosurgeons, rheumatologists, and emergency care practitioners) along with increases in equipment and insurance costs, competition, and regulations, hospitals are going to be pressured over the next five years to reevaluate and bolster relationships with partnering physicians. Hospitals that are able to effectively structure complimentary relationships during this time of change will be rewarded with more dynamic business at the expense of other hospitals as well as physician-owned ambulatory centers, which are expected to be hit hard by reduced Medicare and Medicaid payouts over the next four years. There are six “must-do” actions for hospitals to undertake in order to achieve optimal physician-hospital relations. -Engage physicians in strategic decision making (beyond day-to-day operations) by creating a physician advisory council along with other boards and committees. -Investigate all possible physician-hospital engagement practices (e.g. joint ventures, marketing support) but be sure to brush up on all new laws and regulations—in particular Stark III. -Directly employ physicians with specialties in short supply. -Be aware that arrangements will have to vary with the physician’s age and specialty according to expectations. -Renew focus on relationships with PCPs, enticing them with IT support. Referrals from PCPs will be an increasingly important source of business. -Develop a formal plan and garner both capital support and the involvement of key leaders. Such initiatives are both imperative and opportune, for as the authors of this article point out, “Both hospitals and physicians are more likely to succeed through collaboration than competition.”

Older Physicians Trim Hours in Lieu of Retiring --Employment & Compensation--

Mon, 17 Mar 2008 00:00:00 -0400

Physician shortages are expected to increase as older doctors enter retirement age, and some estimates predict that by 2020, the gap between available and necessary physicians will be somewhere between 85,000 and 200,000 doctors. To fill this void, many older physicians are softening the blow by turning to part-time practice. Research in 2006 by the Association of American Medical Colleges’ Center for Workforce Studies found that 21 percent of doctors over 50 worked part time and a further 46 percent were considering working part time. About 50 percent reported that they could be convinced to work longer before retirement if their hours were reduced or they could work fewer days. Transitioning to part-time employment is not always easy, particularly for doctors with on-call obligations. Many smaller practices simply cannot afford to lessen on-call requirements. Additionally, doctors turning to part-time employment are finding that their income drops substantially. Many older doctors are also turning to locum tenens employment as an alternative to part-time practice. Patrick Donovan, president of the National Association of Locum Tenens Organizations, reports that his Linde Healthcare company in St. Louis has increased locum tenens positions for individuals over 50 from 26 percent to 34 percent in the past year.

A Measured Approach --Employment & Compensation--

Fri, 01 Feb 2008 00:00:00 -0500

Though pay-for-performance tactics are becoming increasingly more popular for both private and public health plans, there are many difficulties associated with the trend. Providing financial incentives for physicians to provide better care often causes more problems than solutions. One major problem with pay-for-performance is establishing an authoritative standard. Depending upon which healthcare provider is offering incentives, different doctors may be subject to completely different standards for the same type of care. Standards can also be incredibly rigid, hurting doctors who have provided exceptional care for unhealthy patients who improve dramatically but fall short of an arbitrarily normalized level of health. This ultimately incentivizes doctors to provide the best treatment to patients who are already in good health. Gathering and organizing all of the data on patient treatment histories is also an administrative headache. Without a thoroughly organized database that contains accurate information on each individual treatment case, some doctors are finding that they are not rewarded for a level of care that surpassed the minimum standards for earning bonuses. Many clinics have added staff specifically devoted to ensuring collected information is current and correct. Many doctors are also complaining about the socioeconomic divide that is caused by pay-for-performance. Studies at the University of Minnesota have found that the greatest determinant for health outcomes is the economic status of the patient, leading critics of pay-for-performance to complain that since programs often rely on patient outcomes, clinics that serve poorer patients are less likely to reap the benefits of any incentives. Pay-for-performance is still a relatively new phenomenon, and there are many kinks that still need to be worked out. Nonetheless, some clinics are finding success with specially customized pay-for-performance tactics designed by the clinics themselves, not their payers, with the doctors optimistic that the programs will remain fair and effective through the future.

How to Do a Medical Practice Buy-In --Employment & Compensation--

Fri, 01 Feb 2008 00:00:00 -0500

In this article, health care attorney Daniel M. Bernick offers some insight on the process of buying into an existing medical practice. For convenience, Bernick sticks to a scenario in which a physician wishes to buy into a practice that has previously been a solo operation. According to Bernick, the first thing to understand is that the senior partner will not be willing to offer a fifty percent stake in a well-established practice off the bat even though he or she could build job protection clauses or a special self-serving bonus structure into the contract. Regardless of share distribution, Bernick points out that while there are three elements of a practice’s value—hard assets (equipment, furnishings, etc), accounts receivable, and intangibles or “goodwill,” new partners prefer to leave accounts receivable and intangibles estimates out of the stock valuation, paying for these assets instead through a reduced income. It is in the best interest of senior partners to account for all assets in the stock valuation, but it is common practice to factor only hard assets, siding with the new partner’s interests. The shifting of a certain amount of income from the junior to the senior partner is akin to “paying dues” (gradually reduced over a short period of time) until an equal partnership is established.

Deposition Dos and Don’ts: How to Answer 8 Tricky Questions --Medical - Legal Matters--

Sat, 01 Mar 2008 00:00:00 -0500

Since 90 percent of malpractice suits are settled out of court, doctors who are facing malpractice suits should prepare for a pre-trial deposition as if it were the real thing. Further, testimony revealed in a deposition can be used if the case goes to trial, and doctors should be extremely careful what they reveal to an opposing attorney. Doctors at SUNY Upstate Medical University and Case Western Reserve University Medical School provide useful advice for doctors involved in an upcoming deposition for malpractice suits. Opposing attorneys will usually try to force doctors into providing testimony that will ultimately secure the case in favor of the plaintiff, and any doctor involved in a deposition should consult with his or her attorney at least two times before the deposition is scheduled. Carefully reviewing all of the details of the case is important here, and doctors should be extremely careful before providing seemingly extraneous information or making broad generalizations about the case. Any deposition should be treated as if it were a real trial, and the standard rules for cross-examination apply. Avoid words like “always” or “never,” and be highly wary of unconditionally agreeing to a plaintiff attorney’s statements. Overall, doctors in malpractice depositions should be very conservative with the facts they reveal and should make thorough preparations with their attorneys prior to the meeting.

AMA Analysis Reaffirms: Tort Reforms Work --Medical - Legal Matters--

Sat, 08 Mar 2008 00:00:00 -0500

An American Medical Association study proclaims that tort reform measures do indeed work to reduce insurance premiums, but trial lawyers and others call the study misleading and its solutions incomplete. An article in the March 3 issue of the AMA’s American Medical News explores the controversy over the efficacy of tort reforms. Reviewing ten independent, peer-reviewed studies that looked at limits of pain and suffering awards and the effects on insurance premiums, physician supply, and defensive medical costs, the resultant summary concluded that the research supported the claim that caps on noneconomic damages result in reductions in insurer claims payouts. These savings, the study concludes, are then passed on to doctors in the form of lower rates, who then pass the same on to their patients in the form of lower prices. The analysis also indicated that tort reforms can help alleviate physician shortages and reduce overall healthcare spending. Also among the study’s findings: -Premiums for internists have been found to be 17% lower in states with caps, while general surgeons’ and OB-Gyn rates were 21% and 26% lower, respectively. -A $250,000 award limit in states without effective reforms could result in savings of up to $1.4 billion on premiums. -States with caps have 4-7% more physicians in high risk specialties than those without. -A 60% increase in medical liabilities from 2000 to 2003 is linked to $7.1 billion increase in spending on physician Medicare Services. Opponents of the study—representatives from the American Asociation for Justice, a national trade group for trial lawyers—voiced concerns about the paper as one-sided and pointed to contradictory evidence from other studies in the past.

Arbitration a Growing Trend in Health Care --Medical - Legal Matters--

Sun, 10 Feb 2008 00:00:00 -0500

How are doctors getting around the potential pitfalls inherent in the litigious modern doctor-patient relationship? An article in the February 10 edition of Philly.com claims that many doctors are asking their patients to agree to arbitration before any services have been provided. Though not providing in-depth numbers on the frequency of doctor-patient arbitration agreements, the article claims it is a common and growing practice on the west coast and shows signs of spreading nationally. It is common in nursing homes especially, with the Golden Living chain—which operates 40 nursing homes nationally—stating that about half its residents agree to arbitration. The practice has come under fire from consumer groups and trial lawyer trade unions, but doctors and organizations adhering to it claim it is the best means of protecting their practices in the face of litigious patients and exorbitant damage awards. Some doctors and patients alike complain that the practice sets an adversarial tone for the doctor-patient relationship from the very start. Partly in response to the controversy, Senator Russ Feingold of Wisconsin introduced legislation last year to prohibit pre-dispute arbitration clauses in medical and other consumer contracts.

How to Handle a Prejudiced Patient --Medical - Legal Matters--

Sat, 08 Mar 2008 00:00:00 -0500

As the American medical field grows increasingly multicultural, there is greater potential for hurt feelings when health care workers encounter patients with xenophobic tendencies. An article in the March edition of American Medical News aims to instruct doctors on how to deal with these patients. The article examines the potential for these types of conflicts, which is heightened in the wake of the 9/11 attacks and increasingly xenophobic media coverage. The author notes that it is not easy to deal with such situations, as they represent a conflict between a patient’s freedom of speech and harassment like unto the sorts classified as workplace hazards by the AMA. The author, however, puts forward a number of potential means for dealing with such troublesome patients: -Remain courteous at all times. The sense of grief and injustice of remarks should never prevent a doctor from doing his job. -Voice your disagreement without being combative. A firm but polite statement reestablishes the physician’s authoritative role and confidence without overly damaging the doctor-patient relationship. -Try to educate your patient. Perhaps approach your patient’s prejudice in a manner similar to the way you’d approach your patient’s alcoholism or smoking: as a habit that is poisonous and needs to be broken through encouragement and support. -Defuse the situation with humor. Keep in mind that the doctor patient relationship is the primary concern, and try to laugh it off or make your patient laugh it off.

Where Are the Women Orthopaedists? --Medical Specialty Focus--

Fri, 01 Feb 2008 00:00:00 -0500

In medical school, women comprise 49 percent of applicants and about 48 percent of enrollees, yet only about 10 to 12 percent of applicants for orthopaedic surgery residencies are women, leaving the field to be dominated by men. Despite that technological advancements have reduced the need for great physical strength in the operating room, many doctors continue to view orthopaedics as an “old boys” network. As the number of orthopaedic surgeons is expected to drop in the near future, substantial efforts need to be made to recruit women to the profession, oftentimes before they even enter medical school. High school career fairs are a good place to start spreading the word about the gender gap, and medical schools, like Johns Hopkins, Harvard, and the University of Minnesota, are developing explicit initiatives to boost the number of female applicants to orthopaedic surgery residency programs. Some other medical schools are beginning to point out these gender discrepancies when students are first enrolled.

Emerging Role for New Niche Specialists --Medical Specialty Focus--

Tue, 01 Jan 2008 00:00:00 -0500

Niche markets for specialty physicians have been emerging over the last few years as a way for new doctors right out of residency to gain valuable positions. As opposed to traditional roles for doctors, there is an increased market for laborists (doctors who treat women, usually uninsured, in labor), surgicalists (doctors who provide 24-hour surgical care), and nocturnists (doctors who primarily work during night shifts). Compensation levels are slightly lower for specialists, and 17 percent of physicians in these categories reported a decrease in overall cash compensation from 2006 to 2007; however, overall salaries for specialists increased by 4.5 percent in 2006, slightly higher than the 4.3 percent increase for primary care physicians. Other specialist categories include hospitalists and pediatric hospitalists.

Primary Care Emphasis Relies on Payment Reform Measures --Medical Specialty Focus--

Wed, 27 Feb 2008 00:00:00 -0500

The current US healthcare system of payment has structural and conceptual flaws that encourage expensive and specialized procedures while discouraging primary care, this according to a recently released report by the government’s General Accounting Office. The GAO’s report indicts the current fee-for-service system as undervaluing primary care services and encouraging growth in specialty services. The report advocates a reform of the payment system that would include increased fees for primary care services as well as a recalibration of payments to properly value all services. The report goes on to advocate for expansion of non-specialty services such as preventive care, coordination of care for chronic illnesses, and continuity of care in order to achieve overall improvement of outcomes and cost savings. The paper extols the values of the medical home model put forward by the American Academy of Family Physicians (AAFP)—a model designed to provide patients with more accessible and comprehensive care with a “basket of services” method. The study also makes mention of the shortage of primary care physicians, pointing out that specialty training program growth has recently outpaced primary care resident growth 8% to 6%. The paper regards this decrease and the impending shortage of PCPs as contributing factors to oncoming difficulties in the health care market.

Decreasing Reimbursements for Outpatient Emergency Department Visits Across Payer Groups From 1996 to 2004 --Payer & Reimbursement Issues--

Sat, 01 Mar 2008 00:00:00 -0500

With the considerable attention recently given to the lost payments for emergency department (ED) visits, a study in Annals of Emergency Medicine sought to understand specifically how much discrepancy exists between payments charged and payments received for ED visits in recent years. Using the proportion of charges that were successfully collected as the criterion, researchers found the overall proportion of charges paid for outpatient ED visits decreased from 57 percent in 1996 to 42 percent in 2004. During the same time frame, charges paid decreased from 43 to 33 percent for Medicaid patients, from 50 to 38 percent for Medicare patients, from 71 to 56 percent for privately insured patients, and from 42 to 35 percent for the uninsured. The authors point out that with a 35 percent rate of charges paid for uninsured patients, hospitals should not see the uninsured as “universally poor payers.” Medicaid patients are actually the biggest source of hospital losses as states and the federal government continue to increase enrollments while decreasing funding. While the study makes few scientific claims about the explanation for these figures, the authors make several key observations. First, though the proportion of charges paid has decreased substantially, the actual amount of money paid by patients has actually increased. This could be attributed to hospitals raising the “sticker price” for various services with the expectation that increased patient payments will compensate for any losses. However, a similar study by the California Medical Association has shown that emergency departments lost approximately $46 per patient treated, causing the number of EDs to decrease by 12 percent during the 1990s, despite increases in ED charges. Second, hospitals may look to further increase charges in the future to hedge themselves against future losses associated with a decreased proportion of payments. This will ultimately harm uninsured patients who would continue to face increased charges for ED visits. Decreases in payment proportions would be magnified as hospitals are legally required to provide care to any patient regardless of their economic status. EDs are an invaluable resource, and substantial thought should be given to sorting out how they can remain financially stable as current trends continue.

AAFP Leaders Call on Congress to Replace Flawed Payment Formula --Payer & Reimbursement Issues--

Wed, 27 Feb 2008 00:00:00 -0500

A .5% increase in the Medicare Physician Payment Rate for the next 18 months is necessary to give lawmakers enough time to develop an alternative to the current sustainable growth rate formula. So says the AAFP in its recent request to members of Congress to take means to stave off deep reductions in Medicare payouts. The last increase in the payout rate came in December of 2007 when Congress approved a .5% payout rate increase that would last through the end of June of 2008. That will expire, however, on July 1, causing a 10.6% cut for physicians, which would be followed by another cut of 5% in 2009. In mid-February, board members of the AAFP met with Congress members to persuade them to amend the current SGR and extend the present rate increase. The AAFP also took time to discuss restructurings to the nation’s healthcare system that are deemed necessary, such as restructuring of pay for primary care and the switch to a “medical home” model of care.

Deciphering the Cost Impact of Managed Care in Medicaid --Payer & Reimbursement Issues--

Fri, 01 Feb 2008 00:00:00 -0500

A study published in the February issue of American Journal of Psychiatry looked at current models for managed care in Florida. The study concedes the findings from previous studies that individuals in the private sector who are accustomed to paying large out-of-pocket fees for mental health services decrease their personal burden through parity and managed care programs. However, this new study uncovers that as managed care reduces the overall cost of providing mental health care to Medicaid patients, costs for individual patients and their families are increasing. The study highlights a growing concern about trends in financing Medicaid programs, namely that they save money for governments and taxpayers while increasing burdens for the patients who require the care. For the editors at American Journal of Psychiatry, this is not an acceptable solution for health care financing. The question of who should be paying for healthcare services can only be answered by addressing the full societal cost for each initiative so that all individuals can receive quality mental healthcare.

Develop an Effective Risk-Management Program --Credentialing, Licensure, Quality Management--

Tue, 26 Feb 2008 00:00:00 -0500

All medical practices need to be vigilant in responding to unexpected events as part of an overall risk-management program. Practices should begin requiring incident reports for events like falls, medication-related occurrences, allergic reactions, equipment failures or improper use of equipment, improper consent, lost or broken valuables, patients signing out against medical advice, misdiagnosis, unanticipated patient outcomes, and when the wrong patient is treated or a wrong procedure is performed. Information in the incident report should include the name of all parties involved, the date and time of occurrence, a description of the event, any equipment that was involved, and the names of any witnesses. Some incidents - death, brain or spinal damage, or procedures performed without informed consent - may legally need to be reported to the state. Staff should be educated in exactly when and how to fill out an incident report. A quality improvement team should be created to address specific instances across all areas of risk-management. By analyzing information in the incident reports, the team can identify trends in medical malpractice and physician mistakes in order to find how to both improve the overall performance of a practice and mitigate the occurrence of accidents and incidents in the future.

Involving Patients in Safety Improvement --Credentialing, Licensure, Quality Management--

Fri, 22 Feb 2008 00:00:00 -0500

Passavant Area Hospital in Jacksonville, Illinois began involving former patients and community members in their safety improvement initiatives over 5 years ago. Passavant’s experience working with individuals outside of the hospital in order to improve safety highlights a unique approach to hospital safety programs. Seeking input from former patients can be an extremely useful tactic for hospitals because these individuals can provide outside advice as to how a hospital can be made safer. It can be difficult to find community members who are willing to be honest and open about their concerns with hospital safety, particularly in a smaller community, but Passavant has been highly successful in treating safety issues they never knew existed. There are some legal concerns with disclosing incident reports or other hospital-specific data to individuals who are not employed by the hospital, and many institutions, particularly in states where privacy is more heavily regulated, are finding that involving former patients in the safety improvement process is too much of a legal liability. Passavant has responded to these concerns by only discussing individual incident reports at a level above the safety committees. Community members still discuss general safety issues within their committees but are prevented from learning any details about specific incidents. Other hospitals ask community members to sign confidentiality agreements that protect hospitals from illegally leaking private information. There are some difficulties involving former patients or community members in safety improvement initiatives in a hospital, but the increased input can be a valuable asset to any hospital seriously concerned with improving safety.

Providers Promote Customer Service to Attract Patients --Credentialing, Licensure, Quality Management--

Wed, 27 Feb 2008 00:00:00 -0500

In the fierce competition between hospitals and independent treatment centers, some hospitals are improving their customer service component to better attract patients. A recent article in the Michigan-based Tri-Cities Business Review explores the tactics in use. The “emotional, social, and spiritual support for caregivers, patients, and their families” will be a major point of focus in programs like St. Mary’s of Michigan’s “The Patient Experience,” its new, customer service initiative begun in February. St. Mary’s customer service focus began in 2003 with the institution of a 30 minute wait time guarantee throughout the hospital. The time limit was achieved by all departments through the alteration of hospital procedures for registration, radiology, and labs. As a result, the hospital is able to meet the 30 minute mark for 98% of emergency room patients. (Those who wait longer than 30 minutes are compensated with two free movie tickets.) Patients are also able to schedule appointments online or by phone, 24 hours a day. Procedures such as these have allowed St. Mary’s to greatly reduce its turnaround time and to eliminate a large amount of its waiting time. The result is a highly satisfied customer base. As a result, patient volume has nearly doubled since the plan began, with the hospital’s patient load nearly at capacity on a regular basis. The focus on customer service resulted in greater efficiency, increased customer base, and a better bottom line.

Pilot Program Reveals Increased Physician Support for e-Prescribing --Healthcare Technology--

Wed, 27 Feb 2008 00:00:00 -0500

E-Prescribing allows physicians to practice better, this according to a recently released survey by Haldy McIntosh & Associates. The study, performed for the Southeastern Michigan e-Prescribing Initiative (SEMI), surveyed 500 physician practices over the course of three years to gauge their satisfaction with e-prescribing. The study found that three out of four physicians surveyed strongly believed that the technology had resulted in an improvement of their practice. They cited the safety alerts in the program that warned of potential drug-drug interactions as a large plus in the program. More than 70% of those surveyed said they were quite happy with the technology, with nine out of ten stating that the technology had met or exceeded their expectations. More than seven in ten doctors reported decreased communications with pharmacies to clear up misunderstandings or correct mistakes, thanks to the technology. Of those, 40% reported a substantial reduction in negative pharmacy contact. More than half of the doctors surveyed reported that the technology saved them and their practices time and increased overall productivity.

Google reveals plan for health database --Healthcare Technology--

Thu, 28 Feb 2008 00:00:00 -0500

Online search giant Google, Inc. announced an online repository for health information storage. The move is believed to be aimed at aiding national adoption of electronic medical records. The service, Google Health, will allow consumers to enter their own medical data, which can then be updated by their doctors, insurers, and other health care workers who have been granted access. The system would put health records at the center of a health information system that would include health insurers, doctors, hospitals, and others. The move puts Google at odds with Microsoft—which launched its own personal health records system, HealthVault, last year—in yet another arena. Google’s system will be based on records that patients authorize their insurers, doctors, and others to move into Google’s database. Google plans to eventually allow the service to become a “platform”—a base upon which other companies can build other software applications using the data. One possible application: a client for automatic management of medications, reminding patients when they should be low on a prescription or in need of a refill. There are, as of yet, no plans to sell any advertising on the service. Google has said the site is intended for now to expand the company’s brand name.

Health Record Banking: A Viable Option for Consumers --Healthcare Technology--

Thu, 28 Feb 2008 00:00:00 -0500

According to a study conducted by the Louisville Health Information Exchange, a sizeable majority of consumers would in fact be ready to support community-wide health record banking systems. Health record banking systems are a sort of central repository, a private and secure location for patients to store their records from all sources via a deposit/withdrawal system. This bank would also be accessible to doctors and other clinical providers. In a telephone based survey also backed by the Noblis Center for Health Innovation, it was found that 69% of respondents would consider a health record banking system valuable, provided it was supported by their particular physician. Twenty-four percent of respondents indicated they would be willing to pay an average of $5 a month for such a service. Most respondents indicated that they would want the ability to opt into or out of the system as they wished and not be automatically enrolled without their consent.

Heading for an Iceberg --Healthcare Technology--

Fri, 01 Feb 2008 00:00:00 -0500

Electronic medical record (EMR) systems can increase hospital efficiency, improve patient safety, and cut costs, but can their implementation also blind executives to other important healthcare IT issues? An article in the February issue of HHN Magazine warns not to get too zoomed in and lose sight of other IT goals and developments. Given the size of the investment in EMR installations, it is understandable that executives could have a rather single-minded approach to the process. However, offerings from private companies, government agencies, and others present options that are more likely to be widely adopted and satisfactory to customers than a particular hospital’s individual system: -Google recently announced Google Health, a free service that will store editable consumer health data that can be accessed by patients, payers, and physicians alike. -Microsoft has debuted a similar system to Google’s in partnership with a smaller company. -The Department of Veterans’ Affairs has 30,000 veterans managed with in-home chronic disease monitoring and coaching. These services are often interoperable with hospital EMR systems but preferred by institutions and patients over individual hospital EMRs. The article recommends that administrators keep an eye open toward healthcare IT developments so as to be able to adopt better implementations and use these resources and services in conjunction with a hospital’s own EMR.

Physicians Face Medicaid’s April 1 Deadline for Tamper-Proof Rx Pads --Industry News--

Mon, 24 Mar 2008 00:00:00 -0400

On April 1st, new Medicaid regulations go into effect that will require physicians to adopt tamper-resistant prescription pads. While various medical organizations claim most doctors are ready for the new regulations, efforts to inform still more continue. The regulations require physicians to have at lest one measure on their written Medicaid prescriptions to prevent unauthorized copying, erasure, or modification. The new regulations were put forth as part of a bill on military spending passed in May of 2007 and developed by the Centers for Medicare & Medicaid Services in conjunction with various healthcare professional organizations. The April 1st deadline is just a beginning. By October 1, 2008, prescriptions will require at least three security measures to meet Medicaid standards. While these standards are set by the states themselves—with Medicaid regulations serving as a baseline—a number of states haven’t chosen to go beyond the Medicaid-prescribed standards. The following is a list of the categories of features to be required by October 1, 2008, as well as a sampling of possible implementations: -Features to Prevent Copying: pantograph, watermarking -Features to Prevent Erasures or Modifications: non-white backgrounds, chemically reactive paper, paper-toner fuser -Features to Prevent Counterfeiting: serial numbers, batch numbers, embedded metallic strips

How Hospitals Can Prepare for the New MS-DRGs --Industry News--

Sat, 01 Mar 2008 00:00:00 -0500

Through 2008, the Centers for Medicare & Medicaid Services will roll out the most significant alterations to Medicare payment in twenty five years. The system—MS-DRG—is aimed at aligning CMS payment to actual treatment costs. The resulting system is more complex, and an article in the March 2008 issue of HHN Magazine explores the steps hospitals will need to take to adjust. The article projects that the new guidelines will result in an increased workload for hospital coding departments, possibly reducing productivity by up to 50 percent. This will require greater collaboration between coders and clinicians for information sharing. The authors recommend an increase in staffing for coding and clinician departments and closer monitoring of the revenue cycles for hospitals as well as monitoring of coding practices. In terms of financial input, the shift is likely to benefit the larger teaching institutions and urban facilities treating patients with higher levels of acuity. Rural hospitals and hospitals treating lower acuity level patients are likely to lose a noticeable amount of reimbursement revenue, though not an overwhelming amount.

High Costs Force Third of Americans to Skip Needed Health Care --Industry News--

Tue, 25 Mar 2008 00:00:00 -0400

According to a new study presented by the AFL-CIO, high costs in health care force one in three Americans to skip needed medical treatments. This is true, says the study, even among insured Americans. The study—the online 2008 Healthcare for America Survey—surveyed 24,619 people between January 14 and March 3, 2008. Of those surveyed, 95% said healthcare needs fundamental change or a complete overhaul. More than 50% of insured respondents said their insurance couldn’t cover needed treatments at a cost they could afford. This ran across education levels as well, with a third of college graduates reporting that they had had to skip care at some point in the last year due to the cost of treatment. Among the uninsured, 76% said they or a relative had had to forego seeing a doctor while sick due to the cost of treatment. The study’s authors and sponsors claim that the results of the survey are indicative of the overwhelming need for a restructuring of the current American healthcare system.

Senate Hearing Questions Doctors’ Ties to Medical Device Makers --Industry News--

Mon, 17 Mar 2008 00:00:00 -0400

The U.S. Senate Special Committee on Aging met in February of this year to discuss the relationship between physicians and medical device manufacturers. A bill was proposed by Committee Chairman Senator Herb Kohl of Wisconsin that would require full disclosure of any gift worth over $25 from any medical device maker to a physician. Between 2002 and 2006, the top 4 manufacturers of artificial hips and knees paid doctors over $800 million in consulting agreements. Though many of the payments were legitimate and fair, government officials argue, further investigation should be made to see whether device manufacturers were forcing their products on doctors in an unethical manner. Most of the manufacturers involved in the case, citing existing disclosure practices at the company level, have denied any wrongdoing. The consulting agreements, they argue, are the best way to test and continually improve new equipment in a clinical setting. Some groups such as the Advanced Medical Technology Association, which represent the makers of nearly 90 percent of health care technology in the United States, created a code of ethics in 2004 that prevents doctors from receiving gifts totaling more than $100 at fair market value. While remaining compliant with the Senate’s investigations, these organizations seek to protect the valuable feedback they are receiving from physicians who use their new technologies. The Senate group recognizes that over-regulating the physicians’ consulting market will ultimately harm medical practices in the United States. Their actions rather seek to prevent manufacturers from unfairly influencing physicians to use their equipment. The proposed bill would limit unnecessary perks while continuing to allow companies to use physicians as a source of research and development. Penalties for violating the bill would not extend to individual doctors.

Hospitals Reuse Devices to Lower Costs --Industry News--

Wed, 19 Mar 2008 00:00:00 -0400

To save on costs and reduce waste, hospitals are recycling a growing number of “single-use” products. A recent article in the Wall Street Journal examines the causes behind this recycling and delves into the question of its safety. Reprocessing companies, hospitals, and environmental groups claim recycling is a safe process due to new procedures that lower risk of product failure or contamination. Reprocessing of medical equipment also results in equipment that is 40 to 60 percent cheaper than new materials. Furthermore, environmental groups state that thousands of tons of waste are eliminated from already crowded landfills through reprocessing. For their part, the medical device manufacturing industry counters by touting the higher risk of device failure, essentially calling the “single-use” label on their devices non-negotiable. A recent study by the Government Accountability Office found no elevated risk incurred from the use of reprocessed single-use devices. Hospitals and reprocessing centers trumpet this finding as additional motivation for recycling medical devices. The process could save the healthcare industry about 1.8 billion dollars a year, according to Ascent Healthcare Solutions, a leading reprocessing company. Ascent also claims a reduction in waste of 1,684 tons by its customers. Despite the protests of the device manufacturers, the reprocessing industry is thriving. The FDA has stepped up its oversight of the industry and is currently at work on guidelines and standards. Currently, efforts focus on ensuring the safety of patients as well as developing a notification system for patients who will be treated with reprocessed products.

Steps to Better Board Accountability --Industry News--

Sat, 01 Mar 2008 00:00:00 -0500

According to a report by University of Iowa Researchers, nearly 90 percent of health systems boards have oversight of quality of care and patient safety, but only 43 percent have a standing committee to look exclusively at community benefit programs. With this figure in mind, a column in the March issue of HHN Magazine lists recommendations for improving hospital governance. The article argues that hospitals need to do more to ensure fulfillment of their community benefit obligations on the whole, noting that the study should open the eyes of hospital administrators as to their obligations and the degree to which they are not meeting them in their particular hospitals. In the face of increased legislative scrutiny on hospitals, their finances, and the degree to which they serve their communities, the author makes the following recommendations on improving governance: -Board development programs should be reviewed and improved to ensure board members are up to date with best practices in hospital governance. -The board’s effectiveness should be regularly evaluated in a manner that can lead to substantial alterations to board policy and makeup if necessary. -The board should state and assign responsibility for clear improvements in its structure to board members and subcommittees with authority to institute changes. -The boardroom culture should be a healthy one that is conducive to change and adaptation and motivated for the improvement of the hospital on the whole. -Governing boards should, as best as possible, reflect the diversity of the hospital’s staff and constituency. -The board should focus on setting and meeting lofty goals regarding its community obligations.

Coordinating Care - A Perilous Journey through the Health Care System --Industry News--

Thu, 06 Mar 2008 00:00:00 -0500

When patients see multiple physicians and specialists for their medical conditions, coordinating between different facilities and practices can be an administrative and financial mess. Opening communication between different physicians and reducing the number of duplicated medical tests can be crucial for limiting the costs to physicians and patients alike. Care coordination, defined as “the deliberate integration of two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services,” should be employed to simplify healthcare wherever possible The New England Journal of Medicine recommends several key coordinated care strategies. Electronic referrals, where primary care physicians will send information on a patient’s condition to a specialist, is becoming increasingly popular. A dermatologist, for example, may only need to see the patient’s medical history and a photograph of the skin condition in order to make an accurate diagnosis. Referral agreements between a PCP and a specialist can also be made where the doctors agree what sorts of treatments should be handled by each physician. These agreements are typically rarer than electronic referrals, but achieve similar effects. When a patient is in a hospital, there are also useful strategies that can be employed. Advanced-practice nurses can take over some of the responsibilities of overworked physicians or specialists while the patient is in the hospital. Other programs send advanced nurse “coaches” to recovering patients’ homes to educate their families about maintaining a basic level of care. Both of these initiatives save substantial sums of money by preempting an expensive visit to an M.D. in the hospital. There are currently several problems associated with coordinated care. Primary care physicians are typically overworked and cannot handle the time commitment required to collaborate with other physicians. There may also be great discrepancies between different practices, such as how a patient’s medical information is stored on a computer, or how the physician will be compensated for his or her work. Small practices may be incredibly susceptible to these sorts of problems. Despite these problems, there are many hospitals that have improved efficiency and costs by reducing unnecessary procedures and utilizing as few personnel resources as possible.

PA’s Chronic Care Management Project --Industry News--

Tue, 01 Apr 2008 00:00:00 -0400

During the first six months of 2007, Pennsylvania’s hospitals reported over $2 billion in charges for persons with chronic conditions for “avoidable hospitalizations” as defined by the Agency for Healthcare Research and Quality. In other words, many patients in Pennsylvania are being unnecessarily hospitalized for chronic conditions, a trend that likely cost the state in excess of $4 billion over the course of the year. This information was recently presented by the Chronic Care Management Reimbursement and Cost Reduction Commission (CCMRCRC), which has developed a strategic plan to: -Implement a new primary care reimbursement model that permits primary care practices to provide additional resources to proactively care for patients with chronic conditions; -Broadly disseminate the Chronic Care Model to primary care practices across Pennsylvania; -Achieve tangible and measurable improvement in the quality of care for chronically ill patients; and -Reduce the cost of providing chronic care and implement mechanisms to ensure that savings are realized by those paying for health care. Ann Torregrossa, the deputy director and director of policy for the Governor’s Office of Health Care Reform in Pa., stated that many advisory members of the Commission were “telling us that, if we did not change how chronic care was being provided at the community level in Pa., we would continue to have serious quality and cost issues.” She acknowledges, however, that implementing their strategic plan faces many obstacles, including the lack of training patients receive in self-management of their conditions, which leads to an overreliance on primary care physicians, and the financial pressures physicians face to see as many patients as possible as quickly as possible to cover overhead costs. The project being advanced by Torregrossa and others is based on the Wagner Chronic Care Model, which has six key components: self-management support, delivery system design, decision support, clinical information systems, partnership with community resources, and health system incentives for quality improvement among caregivers.

Q&A: Common Questions About Locum Tenens Pay Rates --Employment & Compensation--

Sat, 01 Mar 2008 00:00:00 -0500

Fair and appropriate payment rates are a source of confusion within and outside the Locum Tenens (LT) community. An article in the March 2008 issue of LocumLife takes time to answer a number of commonly asked questions regarding the payment of locum tenens physicians. Pay rates are determined primarily by the demand for LT services. While they may vary by location, locum tenens pay is largely determined by the demand for particular practitioners. LT professionals should take this into account when deciding on a region in which to practice. While there is room for negotiation of pay—if, for instance, a doctor is ready to work longer hours or for a prolonged period at one location—pay rates are generally rather inflexible once agreed upon. Searching for higher pay in an area, shopping around services to other providers for higher pay offers, may in fact be in violation of a practice contract and can result in termination or legal action, depending on the contract. -Pay is calculated typically on a per diem basis, with premium pay available for exceptionally long shifts or work weeks. Holiday pay rates vary according to many factors, including location, facility standards, and physician exceptionality. The physician doesn’t directly collect fees for services. The collection of fees is left up to the hospital or hosting institution. -Locum tenens agencies pay the physician directly, after charging clients a slightly higher amount. The agencies generally handle the administrative and procedural legwork for locum tenens practitioners, justifying their cut by handling the logistical workload for physicians. -Income taxes are the responsibility of the individual physician. Locum tenens physicians are paid as independent contractors and, as such, do not have taxes withheld. Locum tenens practitioners fill out Form 1099, and it is advisable to set up a special escrow account for independent withholding.

Keys to Effective Physician Compensation --Employment & Compensation--

Tue, 01 Jan 2008 00:00:00 -0500

While indispensable to a practice’s operation, the development of an effective compensation plan for physicians can prove to be quit the headache. An article from the Healthcare Strategy Group examines the factors that must be taken into consideration in crafting a compensation plan. Compensation plans must strike a balance between competitive physician compensation and competitive practice pricing. A number of methods exist for pricing plans, including fixed salary, productivity based pay, fixed salary with the added bonus of productivity incentives, and any of the preceding with added bonuses for meeting goals and benchmarks in quality of care. The article recommends taking patient charges, relative value units, and patient encounters into consideration when choosing which among these systems to employ. In developing a compensation plan, the article has a number of suggestions. Chief among them is the establishment of clear expectations. In this manner, physicians know what is expected of them and what they’ll receive in return. Also important factors are the simplicity and sustainability of the plan. Overall, the article recommends a certain degree of flexibility in compensation plans to incentivize high performance.

Measuring a Practice’s Financial Progress --Physician Practice Management--

Sat, 01 Mar 2008 00:00:00 -0500

The business side of practicing medicine is often a necessary but distasteful necessity for physicians. However, come payday or tax time, having your financial house in order is as essential to the practice as the actual medicine. An article in the March edition of Physician’s News Digest explores the ins and outs of keeping a tidy practice on the financial end. The article lays out the four essential steps for a financially health practice: -Set expectations with a budget: the author recommends the establishment of a budget at the beginning of each year for comparison with actual results throughout the year. Having a budget aids in guiding determination of a realistic amount of compensation for shareholders, as well as revealing anomalies in revenues and expenditures. Budgets should be prepared by financially experienced office managers or accountants if necessary. -Cash management: maintenance of cash flow is essential to practice operation. The strength of a practice’s cash flow is determinable through a number of measures, such as turnover of receivables, insurance payments, and assets divided by liabilities. The cash flow of a practice is a figure to keep in mind at all times. -Know your true net income: having a true picture of a practice’s net income is essential to developing a real grasp of the fiscal health of the practice. The use of receivables and payables in consideration of profitability is recommended. Practices ought to track profits through accrual methods and modified cash methods to maintain a true view of financial obligations and outlays. -Understand revenue and expenses analytically: figures should be compared year over year to develop a picture of the norm for a practice and spot anomalies and inefficiencies. If you know your practice’s resting financial pulse, you can easily tell when something is amiss.

Learning to Love the System You’re (Stuck) With --Physician Practice Management--

Tue, 01 Apr 2008 00:00:00 -0400

According to Richard Frankel, a health services and qualitative researcher who has spent the past 30 years studying clinician–patient relationships, improving the “interviewing skills” of all American physicians by 10 to 15 percent would transform the face of American medicine. His latest research suggests that it is not so much the amount of time clinicians spend with their patients in the exam room, but rather how that time is spent. The shift in emphasis advocated by Frankel and his team recognizes that time is money, and that health care in the United States is a marketplace commodity rather than a social good. Through the lens of the “15-minute model”—which will remain the dominant model in health care services barring a significant overhaul of the current system—there are a few ways that physicians can make the most of the patient interactions they do have. Dr. Dave Davis, a Toronto-based family physician, has consciously cultivated his listening skills and begins each office visit by asking the patient “What do you think is going on?” This helps him know the patient in a professional sense and can help avoid unnecessary testing. Davis says that these minor “communication techniques” establish a mutually agreeable template from which physicians can deliver targeted, quality care. Frankel and his fellow researchers see a lot of similarities between Davis’s approach and the “four habits of highly effective physicians” that they formulated over a decade ago. Those habits are: 1) invest in the beginning of the visit, which is about greeting patients and negotiating the visit’s agenda with them; 2) eliciting the patient’s story; 3) demonstrating empathy; and 4) investing in the end of the visit.

Chart Mistakes That Can Burn You --Physician Practice Management--

Sat, 01 Mar 2008 00:00:00 -0500

Documentation of a patient’s treatment can leave a physician open to a good deal of liability if one isn’t careful what one says. Seemingly innocuous statements could be the lynchpin for a plaintiff’s case if they are vague enough or can be construed to be misleading. An article in the March issue of Contemporary OB/GYN has notation pointers for the physician looking to avoid litigation. The article names three main areas regarding charts and notation where physicians commonly run into litigable problems, giving general pointers on content and style that can help avoid costly lawsuits: -Choose your words carefully. Be careful not to understate or exaggerate evaluative statements. Always use concise terms and avoid vague or noncommittal words, which leave room for questioning and conjecture. -Filter what you write down. References to risk management or legal services leave open the possibility that a physician knew something was wrong with the treatment prescribed. Likewise, negative characterizations of patients can open the door to litigation, and undue conjecture can be shown as a sign of malpractice if a doctor assumes incorrectly on a patient’s status or history. -Don’t omit critical information. Family input, confounding factors, and medical reasoning are all important factors that should be included in notation on a chart to provide a fuller view of a patient’s overall experience with treatment. This leaves less wiggle room for plaintiffs, further shielding a practice from litigation.

Malpractice Consult: When You Need Tail Coverage --Physician Practice Management--

Fri, 04 Apr 2008 00:00:00 -0400

Most malpractice insurance available today comes in the form of claims-made coverage rather than occurrence coverage, which means that insurance carriers will only cover claims that are filed while the policy is in force, not all incidents that occur during the policy period. The author of this recent article in Medical Economics recommends that companies continuously renew their claims-made policy to ensure coverage for incidents that took place in previous policy years, back to when that policy began. If companies change carriers, however, or if individual physicians retire from practice, they will no longer be covered for events that transpired while the policy was in force—unless, that is, you purchase some form of tail coverage. Tail coverage essentially turns a claims-made policy into an occurrence policy, so that all claims related to incidents that took place during the policy period will be covered regardless of when the claim is made. Almost all insurance carriers offer tail policies, according to the author, but they can be very expensive. Another, similar way to ensure continued liability coverage is through prior acts coverage, which will make new coverage retroactive to whatever date is set forth in the policy. Typically, costs are directly correlated with how retroactive the coverage is set (i.e., the more retroactive the coverage, the higher the premium).

Have You Really Addressed Your Patient’s Concerns? --Physician Practice Management--

Sat, 01 Mar 2008 00:00:00 -0500

Family physicians often pride themselves on their connection to and knowledge of their patients. However, research has shown that between 30 and 80 percent of patient expectations are not met in routine primary care visits. What could physicians be missing? An article in the March 2008 issue of Family Practice Management explores what physicians need to do to better connect with patients and address their needs. The article places a good deal of the blame for patient dissatisfaction squarely on physicians, noting that analyses of recordings of patient-physician visits show physicians redirecting patients within 30 seconds of the patient starting to express their concerns. Furthermore, patients are generally removed from decision making, and doctors display little empathy. As a remedy, the authors suggest the adoption of a more patient-centered communication approach to more actively involve the patient in his own care. The patient-centered approach centers on eliciting and prioritizing patient concerns so that the treatment is not based solely on the physician’s estimation of the problem and the physician’s time constraints, but on the patient’s concerns and expectations as well. The authors recommend a more decompressed initial patient interview that allows the doctor to tease out patient symptoms and concerns. Patients should also be informed of their treatment options and the benefits and risks of all options. Ultimately, they believe, the overall climate of the visit is positively affected, resulting in a better doctor-patient relationship and better treatment on the whole.

Lab Tests Don’t Make Diagnoses, Doctors Do --Physician Practice Management--

Fri, 01 Feb 2008 00:00:00 -0500

Dr. Joseph Alpert at the University of Arizona College of Medicine comments on the need for physicians to consider laboratory results of patients’ conditions in the scope of the general clinical picture. Relying too heavily on a singular approach for identifying disorders can result in unwanted and deleterious misdiagnoses. Using acute myocardial infarction as the focal point of the commentary, Dr. Alpert discusses how certain indicators revealed in a laboratory test, for example abnormal blood troponin levels, are not the lone means for diagnosing the condition. He provides an example of a woman who was mistakenly diagnosed with myocardial infarction based on a single laboratory test taken following a negative reaction to anesthesia. When the woman applied for life insurance several years later, she was denied coverage based on her supposed condition. The takeaway message from Dr. Alpert’s comments is that laboratory tests alone are an insufficient criterion for diagnosing complicated medical conditions. There may be signals that highlight the potential existence of certain conditions, but without considering a host of issues - from the patient’s medical history to a physical examination - diagnoses can never be certain.

Why We’ve Never Been Sued for Medical Malpractice --Medical - Legal Matters--

Sat, 01 Mar 2008 00:00:00 -0500

How could a six-doctor internal medicine and rheumatology practice never have had a lawsuit filed against it in 30 years of practice? Luck? Incomparable skill? The head doctor of the firm explains in an article in the March issue of Medical Economics that that record didn’t come cheap, but it is well earned. The author notes that lawsuits often grow out of unrealistic patient expectations, though a certain degree of luck does help, and lays out nine factors and traits that have contributed to the practice’s impressive run: -Document, ad nauseam: failure to diagnose is the most common trigger for a lawsuit. Thorough documentation, with fully articulated descriptions of patient conditions and proposed treatments, will not only insulate a practice from allegations of negligence, but also likely result in better treatment. -Communicate with patients: practices should have incoming calls answered by a person, not a machine. Calls should be returned as soon as possible to ensure prompt assessment of a patient’s condition. Contact should be maintained with patients, for it will make them feel as though they are a part of their treatment, which will make them more likely to volunteer information. -Be available: the author urges same-day sessions for patients reporting urgent problems. If at all possible, patients should be seen immediately if they feel they need to be seen. This results in longer hours for the practice, but longer hours spent in the office are better than long hours giving depositions. -Triage: the author recommends that physicians be liberal with referrals and insists on regular visits from difficult patients. -Stay current: be up to date on the latest in Continuing Medical Education. A new technique could save a patient’s life. -Practice health management: doctors should encourage wellness in their patients, counseling them away from bad lifestyle choices such as unhealthy eating and smoking. -Weed out bad apples: if you must “fire” a patient, do so. But do so in non-confrontational language that ensures the patient knows the practice is still there to help with record transferal, referrals, and provision of emergency care if necessary. -Consider extrinsic factors: take a look at your malpractice insurance carrier. The author says the quality of the carrier is a huge factor. The quality of representation available is also a factor, as is the carrier’s willingness to settle cases.

Where Does the Physician’s Duty to Warn End? --Medical - Legal Matters--

Thu, 28 Feb 2008 00:00:00 -0500

Does the physician’s duty to warn of potential side effects extend to third parties with no relationship to the physician? Yes, says the Massachusetts Supreme Court, in a case that could have an impact on practices nationwide. The case—Coombes v. Florio—centers on an accident involving a ten year old boy, Kevin Coombes, who was struck and killed by a patient under the influence of a certain medication that impaired their ability to drive. The boy’s estate sued the prescribing doctor, who had been coordinating the treatment of the patient, claiming that his insufficient warning of the side effects of the medication made him liable in the boy’s death. The court’s finding, a majority opinion, was that the doctor could indeed be found liable by a jury for negligence leading to the boy’s death. The trial may very well proceed to a jury, and so the author of the column believes it may raise issues for physicians on a wider scale. On the whole, the author recommends that involved parties do their due diligence and more to explain to patients and caregivers the potential side effects of medications. Thorough discussion of the side effects should also be thoroughly documented to limit physician exposure in these and similar cases in the result of litigable mishaps.

Avoiding Legal Traps in Health Care Growth with Non-Profits --Medical - Legal Matters--

Tue, 25 Mar 2008 00:00:00 -0400

In the face of a constantly shifting healthcare industry, with advancements in technology and treatment and shifting demographics, it is easy for providers to lose track and fall behind the times. An editorial in Healthcare Review, however, states that administrators must stay on their toes with regards to their non-profit status in order to avoid legal troubles. The article argues that the variety of state laws and regulations determining non-profit responsibilities can have the effect of creating pitfalls for charitable institutions. A hospital’s non-profit or charitable status can shift with something as simple as a gift or endowment that is deemed to be not in keeping with the will of its initial donors. Pitfalls are possible in mergers and decouplings of institutions, and great care must be taken in navigating the legal landscape for hospitals, which likely lack the financial resources for protracted legal battles over the minutiae of bylaws. The author recommends the retention of a lawyer well-versed in charitable trust law, just in case a particular institution’s state laws prove treacherous to the uninitiated.

Expert Who Changed Mind Claims Immunity, but Plaintiffs Still Sue --Medical - Legal Matters--

Mon, 14 Apr 2008 00:00:00 -0400

A U.S. District Court will soon consider a case in which two plaintiffs are suing their physician expert witness for medical liability after the doctor changed his opinion during pretrial proceedings and their (the plaintiffs’) lawsuit was eventually dismissed. The original lawsuit brought forth by Thomas and Karol Pace was against anesthesiologist Stephen Shuput, MD, one of the doctors who treated and released their daughter after breast augmentation surgery. She died shortly after her release, prompting the medical liability suit. The current lawsuit, filed in Utah state court, accuses anesthesiologist Barry N. Swerdlow, MD, of malpractice, fraud, negligent misrepresentation, breach of fiduciary duty, breach of contract, breach of the implied covenant of good faith and fair dealing, and negligent infliction of emotional distress. The couple alleges that Dr. Swerdlow, acting as an expert witness in their case against Dr. Shuput, unlawfully changed his position after his initial court deposition, and that this decision was a proximate cause of the state court judge's decision approximately a month later to dismiss their medical liability claim against Shuput. Having requested and received a copy of Dr. Shuput’s deposition after giving his own deposition, Dr. Swerdlow amended his deposition to say that he thought Dr. Shuput’s care and specifically his decision to discharge the Paces' daughter, was within the standard of care. In the ruling, the Utah judge stated that one of the reasons the claim was dismissed was that Dr. Swerdlow’s deposition testimony and addendum failed to meet the grounds necessary to pursue any medical malpractice claims. Rather than appeal that decision, the Paces sued Dr. Swerdlow. They alleged that his change of opinion on the eve of trial was the “proximate cause” for the state court to dismiss their medical liability claim against Dr. Shuput. Under the doctrine of witness immunity, a plaintiff cannot sue defense witnesses for an adverse judgment under the theory that expert witnesses should be permitted to testify freely without fear of finding themselves liable for their testimony, but the Paces argue that other federal jurisdictions that have addressed this question have refused to allow an exception to bar plaintiff claims against friendly experts.

Bypass of Local Primary Care in Rural Counties: Effect of Patient and Community Characteristics --Medical Specialty Focus--

Tue, 01 Apr 2008 00:00:00 -0400

What factors affect the likelihood of rural patients seeking care outside the local community? Is such bypassing a result of hospital size? Availability of primary care providers? A study in the March-April issue of Annals of Family Medicine examines the incidence of bypass and its causes. The study looked at data from a 2005 telephone survey of 1,264 adults who lived within 20 to 25 miles of randomly selected critical access hospitals. This data was then compared with a Health Professional Shortage Area study and 2004 Census data. The study found that 32% of respondents had bypassed local primary care at some point, with incidence of bypass ranging by region from 9 to 66 percent. Affecting factors were age, education, marital status, local hospital satisfaction, health, and local hospital size. Residents in areas with lower densities of primary care providers were more likely to bypass their local hospitals than were residents in higher density areas. Lack of specialists and limited service offerings were the most frequently cited causes of local hospital bypass. The authors of the study conclude that strategies to encourage local hospital use should be directed at the individual and facility level as opposed to a broader plan. Local hospitals need to increase the familiarity levels of their surrounding communities with their offerings and services. This would serve to raise consumer confidence in the local medical establishment. Furthermore, an increase in the number of primary care providers is also recommended for low-density areas.

Insurers Begin to Reimburse Physicians for Online Visits --Payer & Reimbursement Issues--

Mon, 31 Mar 2008 00:00:00 -0400

In a move viewed by some as the beginning of a possible trend, health insurers Aetna and Cigna have announced that they will reimburse physicians for online visits and also require a copay from patients. The two companies maintain contracts with RelayHealth, which provides a secure site to doctors for administrative duties and other features. Patients complete questionnaires on the RelayHealth site that can aid doctors in the preliminary diagnosis of around 150 illnesses. Aetna announced it was expanding its pilot program with RelayHealth beyond California on January 1 of this year, while Cigna indicated that their program will begin in January of 2009. The site functions predominantly as a means to streamline physician administrative duties and is relatively scarcely utilized, though industry figures believe that the online component of healthcare is bound to increase greatly in popularity in the coming years.

Outlook Remains Bleak for Two Programs --Payer & Reimbursement Issues--

Wed, 26 Mar 2008 00:00:00 -0400

The financial outlook for the nation’s Medicare and Social Security Programs is grim according to figures released by the Bush Administration. A new report, detailed in the March 26 edition of the New York Times, warns that Medicare will exhaust its hospital insurance trust fund by the year 2019. The report is likely to put pressure on the remaining three presidential contenders to expand upon their proposed solutions to the solvency problems of Medicare. Medicare has a separate trust fund for the payment of doctors, and the trustees see a steep increase in operating costs, though the fund will not run out of money upon expiration of its trust fund due to its access to general revenue and adjustable benefits, characteristics that are built into the program by law. Currently, the standard premium for Medicare Part B is at $96.40 per month, having increased some 64% over the last five years. At the present formula, it would stay level through 2010. However, figures in the report—which takes into account actual costs as opposed to costs including projected payout cuts—indicate that the premium is bound to rise. For their part, both parties in Congress appear to be busying themselves with laying blame for the coming insolvency and the deadlock over what to do about it at each other’s doorsteps.

Bill Advances to Suspend Medicaid Cost-Shift Rules --Payer & Reimbursement Issues--

Thu, 10 Apr 2008 00:00:00 -0400

Recently, the House Energy and Commerce Committee's health panel unanimously passed a bill that would block certain Medicaid rules that many states said would shift billions of dollars of costs to them. The bill would put a moratorium on seven rules that would end federal payments for physician training and transportation of Medicaid-eligible children to school, among other initiatives. Because the Congressional Budget Office has estimated that the seven rules would save the federal government $1.65 billion for fiscal years 2008 and 2009, the onus is on lawmakers to find savings elsewhere. To help reach that number, the current bill requires more scrutiny of Medicaid beneficiaries' eligibility. The expectation is that some will be disqualified because their assets exceed the program's guidelines. In addition, Commerce Committee Chairman Rep. John Dingell offered a version of the legislation that would give the Department of Health and Human Services an additional $25 million a year to reduce Medicaid fraud and abuse, thereby cutting overall costs. The moratorium on the rules has unique bipartisan support: all of the nation’s governors support the bill as a welcome relief from other budget crunches. Medicaid accounts for 20 percent or more of state spending, and the number of enrollees tends to rise when the economy slows down.

Medical Errors Costing U.S. Billions --Credentialing, Licensure, Quality Management--

Tue, 08 Apr 2008 00:00:00 -0400

According to the fifth annual Patient Safety in American Hospitals Study, patient safety errors resulted in 238,337 potentially preventable deaths of U.S. Medicare patients and cost the Medicare program $8.8 billion between 2004 and 2006. Released by HealthGrades, a health care ratings organization, the analysis was based on 41 million Medicare patient records and found that the overall medical error rate was about three percent for all Medicare patients. Among the study’s other major findings: -Patients who experienced a patient safety incident had a 20 percent chance of dying as a result of the incident. -The most common types of medical errors were bed sores, failure to rescue, and post-operative respiratory failure. Together, they accounted for 63.4 percent of incidents. -Of the 270,491 deaths that occurred among patients who experienced one or more patient safety incidents, 238,337 (or 88%) were potentially preventable. -If all hospitals performed at the level of the top-ranked hospitals, about 220,106 patient safety incidents and 37,214 patient deaths could have been avoided, and about $2 billion could have been saved. Officials at HealthGrades emphasized the importance of poor-performing hospitals recognizing that the benchmarks set by the Distinguished Hospitals for Patient Safety are achievable and associated with higher safety and markedly lower cost. Doing so would likely alleviate the current toll of lives and dollars that burdens health care systems.

Hospitals That Participate in Clinical Trials May Provide Better Patient Care --Credentialing, Licensure, Quality Management--

Tue, 25 Mar 2008 00:00:00 -0400

Participation in clinical trials appears to be tied to better patient care, according to a new report from the Duke Clinical Research Institute. The study, based on analysis of data from 174,062 patients, looked at treatment outcomes for patients with specific heart conditions at 494 hospitals. It found that in-hospital mortality decreased with increased trial participation at hospitals. Patients at hospitals that had participated in trials showed significantly lower mortality rates than those at non-participating hospitals. While the study’s authors hope the study will alleviate fears of administrators wary of participating in clinical trials due to costs and potential downsides, they posit that the real effect of trial participation on mortality rates is likely due to administrative and procedural structures in place in hospitals that are likely to successfully complete clinical trials.

Hospital Medicine Mix-Ups Rising --Credentialing, Licensure, Quality Management--

Mon, 07 Apr 2008 00:00:00 -0400

According to a recent study to be published in the journal Pediatrics, medicine mix-ups, accidental overdoses, and bad drug reactions harm roughly one in 15 hospitalized children. That number is much higher than earlier estimates and highlights growing concerns among the public, thanks in large part to a few highly publicized cases in recent months. Thanks to a new monitoring method, developed in part by the National Initiative for Children's Healthcare Quality, researchers found a rate of 11 “drug-related harmful events” for every 100 hospitalized children, which translates to about 540,000 children each year. While traditional methods of detection relied heavily on nonspecific patient chart reviews and voluntary error reporting, the new tool is a list of 15 “triggers” on young patients' charts that suggest possible drug-related harm, and it includes use of specific antidotes for drug overdoses, suspicious side effects, and certain lab tests. Some patient safety advocates aver that the problem is even bigger than this study suggests because it involved only a review of randomly selected medical charts for 960 children treated at 12 freestanding children's hospitals nationwide in 2002. Furthermore, the study did not include general community hospitals, where most U.S. children requiring hospitalization are treated. More than half of the problems the study found were related to overdoses of morphine and other powerful painkillers.

Online Physician Communication --Healthcare Technology--

Sat, 01 Mar 2008 00:00:00 -0500

As the information age progresses, information technology has an impact on more and more areas of everyday life. How are computers and personal communication devices impacting the healthcare field? An article in the March 2008 issue of Physician’s News Digest takes a look. Fully 31 percent of physicians have reported communicating online with patients in the first quarter of 2007. This was up from 24 percent in 2005 and 19 percent in 2003. While the telephone remains the predominant mode of communication, this growth speaks well to the increasing power of information technology in the healthcare world, as well as the increasing comfort of patients and physicians with information technology. Doctors are beginning to carry a greater number of personal communications devices—miniature computers that allow for more detailed communication and automatic alerts—on their person at all times. This allows for them to be reachable in more places with more capabilities at their disposal. Surveys indicate that patients are also ready to have a greater reliance upon information technology in their healthcare experience. One survey found that 62 percent of patients wanted the ability to communicate electronically with their doctor. Another survey asking the same question put the number at 74 percent. Still other surveys indicate that patients are willing to pay $25 for online consultations with their physicians. A number of issues arise from this IT surge—namely, privacy and security. A number of regulations are currently in place regarding electronic standards in medical record transmission and storage. Doctors should be aware of these particular regulations before undertaking any information technology upgrades to their practices. Despite the potential pitfalls of IT, the benefits seem to far outweigh the possible costs. IT implementations can lead to faster, more accurately practiced medicine at a lower cost to providers, payers, and consumers. For this reason, a large number of IT solutions have presented themselves to the healthcare industry, and this number appears to grow by the day.

New Studies Show Benefits of IT on Patients --Healthcare Technology--

Wed, 09 Apr 2008 00:00:00 -0400

According to 11 research studies conducted by the Center for Connected Health, a division of Partners HealthCare in Boston, connected health technologies are making it possible for patients to better manage their care. Researchers found growing evidence demonstrating the benefits of “connected health” for patients, healthcare providers, employers and payers, as well as for the person who simply wants to stay healthy. Examples of connected health technologies advocated by Partners include the following: -A telemonitoring program for heart failure patients: Non-homebound heart failure patients participating in the Connected Cardiac Care program were given home telemonitoring equipment to transmit daily vital signs and symptom reports to a nurse. Initial feedback from participants has been overwhelmingly positive, with all patients reporting that the program has improved their overall health and helped them stay out of the hospital. -Blood sugar monitoring for diabetes patients: Electronic communication between providers and patients outside of scheduled office visits was seen as important in improving diabetes management, and patients have reported that blood sugar monitoring was most valuable when newly diagnosed or for patients trying to regain control of their diabetes.

Georgia Urges Physician Uptake of EHRs --Healthcare Technology--

Mon, 31 Mar 2008 00:00:00 -0400

In what some have called a tremendous opportunity to transform healthcare delivery in Georgia, the Georgia Department of Community Health launched an electronic health records (EHR) initiative aimed at increasing the adoption of EHR among small and medium-sized physician groups. The state plans to apply for participation in a Centers for Medicare and Medicaid Services-sponsored Medicare Demonstration Project, during which financial incentives will be provided to physician groups for EHR adoption and clinical quality benchmark achievement. Proponents of the new initiative and electronic health records point out the potential benefits of EHR to patients, doctors, and healthcare organizations overall. In addition, they point out the potential cost savings for consumers, private payers, and government services as a reason for widespread adoption.

Why Is It So Tough to Deliver on E-Prescribing’s Promise? --Healthcare Technology--

Fri, 01 Feb 2008 00:00:00 -0500

Electronic prescribing improves patient safety and reduces overall costs according to most industry experts. So why has adoption proceeded at a crawl? An article in the February issue of Managed Care magazine examines the impediments to E-Prescription adoption. Only two percent of the roughly 1.5 billion prescriptions filed in the year 2007 were filed electronically. This ratio persists in spite of the demonstrable benefits of electronic prescription filing, which include dramatic improvements in patient safety and the accelerated adoption of other beneficial information technology in medicine. It has been calculated that errors and events possibly preventable by electronic prescriptions cost the healthcare industry and consumers approximately $27 billion per year. Major impediments to adoption of this life and money saving technology include the cost prohibitiveness—it can cost up to $27,000 for a practice to implement E-Prescribing hardware and software—and a general stubbornness among the physician community. Industry figures are calling for a greater role to be taken by the government in the establishment of standards regarding electronic prescriptions. In particular, industry spokespersons call for faster adoption of the standards from the Medicare Modernization Act of 2003, which called for greater implementation of information technology in the medical administrative sphere. Attempts to modernize, though, are likely to run up against obstacles, such as current regulations that deem it illegal to transmit certain kinds of prescriptions electronically. Observers note that it will take greater cooperation between organizations, industry figures, and government to ensure operable standards that encourage adoption of technological solutions.

The EDD’s Challenge --Industry News--

Fri, 01 Jul 2005 00:00:00 -0400

In 2005, a ruling by California’s Employment Development Department (EDD) raised concerns for locum tenens companies and physicians. Where physicians in locum tenens arrangements had always been considered “independent contractors” by their staffing firms, the new California law dictated that these doctors now be considered employees of the locum tenens organizations. Several concerns surround this decision. The new rulings, first of all, make locum tenens firms culpable in any malpractice suits filed against physicians. The liability necessary to cover these suits is prohibitively expensive and may have forced many physicians to coordinate their own locum tenens employment opportunities within the state. Further, by establishing a more formal business arrangement between staffing firm and physician, the rulings placed non-physicians in a position to influence how doctors are practicing medicine. By taking away physicians’ status as independent contractors, there are serious concerns regarding doctors’ autonomy in the hospital or practice.

Raising Awareness Concerning Physician Suicide --None--

Sat, 31 May 2008 00:00:00 -0400

Raising Awareness Concerning Physician Suicide

Health Plans Embrace Retail Clinics --Industry News--

Sat, 01 Mar 2008 00:00:00 -0500

For time-constrained consumers with minor healthcare needs, retail clinics are becoming a fast-growing phenomenon as an alternative to primary care practices. Usually located in grocery stores, large retailers like Target, and other commercial spaces, retail clinics are an easy way for individuals to receive quick outpatient medical care in the span of about 15 minutes. For a small fee, consumers can access cures for very simple medical procedures like ear infections, strep throat, and poison ivy. Many clinics do not even have a full-time physician on hand. For more serious medical conditions, the clinics advise their patients to visit either a traditional doctor's office or else an emergency room. Insurance companies are jumping on the bandwagon and covering their customers' visits to these clinics as a cheap and easy solution to overburdened physician's offices and ERs. At the beginning of 2007 there were just 150 retail clinics in the United States, and as of March 2008, this number has risen to over 900. With companies like Wal-Mart hoping to open 2,000 retail clinics in their existing stores within 7 years, these figures are expected to rise dramatically. As the new generation of healthcare seekers are increasingly accustomed to the consumer mentality, quick in-and-out health services for minor procedures are becoming more desirable. According to a 2008 Deloitte Survey of Health Care Consumers, 16 percent of American consumers claim to have used a retail clinic in the last year, and 34 percent of those said they would visit one again. Forty-eight percent of consumers said they would visit a clinic if the nurse practitioner were connected to a physician's office in the local area. Some doctors are concerned that the rise of retail clinics will result in "fragmented care," and there are concerns about the quality of services that these for-profit offices can provide. Nevertheless, the traditional model of healthcare will need to adjust its practices to accommodate for this rapidly growing trend.

Physician Suicide --None--

Thu, 01 May 2008 00:00:00 -0400

Physician Suicide

From Red to Green --Industry News--

Tue, 22 Apr 2008 00:00:00 -0400

Employing nearly 5 million workers, U.S. hospitals are big operations that stay open 24 hours a day, seven days a week with lights on, kitchens running, and trash piles growing around the clock. Collectively, hospitals burn 600 BTUs of energy each year at a cost of over $5 billion, and they generate millions of tons of garbage with the majority of that being highly toxic waste. “Going green” has become an ethical, regulatory, and economic imperative for U.S. hospitals and thanks to a new initiative, Practice Greenhealth, it is getting easier for hospitals to be ecologically responsible. Congress passed the Medical Waste Tracking Act in 1988 in response to incidents in which large amounts of medical waste washed ashore in New York and New Jersey. Three years later, hospitals were responding. Many were monitoring waste bags, winnowing energy consumption, phasing out polystyrene products, recycling, and experimenting with eco-friendly waste disposal technologies. Unfortunately, these trends did not catch on with a majority of hospitals. Due to high federal costs of waste tracking and medical waste disposal, many hospitals built incinerators and started burning everything. These incinerators had huge impacts in lowering the quality of air and water in surrounding areas. In 1997, the EPA began enforcing stringent air emissions standards for hospitals and their medical waste incinerators, vowing to cut mercury, particulates, hydrogen chloride and dioxin pollution by 90 percent. The EPA also joined with the American Hospital Association and formed Hospitals for a Healthy Environment (H2E). Since then, thousands of clinics and health care facilities have joined H2E, and 80 percent of U.S. hospitals have implemented some form of waste reduction policy. Currently, nineteen health care facilities have been built in the U.S. and British Columbia to meet the standards of the U.S. Green Building Council. As a successor to H2E, Practice Greenhealth offers the educational resources of H2E but also makes available its guide for safe, efficient, environmentally friendly design, construction and operations, “The Green Guide for Health Care,” plus a promising new approach to major savings in electricity procurement through the Internet-based reverse auction technology of the Healthcare Clean Energy Exchange.

Leavitt Pitches Urgency, Tougher Stance on Value-Driven Healthcare --Industry News--

Thu, 24 Apr 2008 00:00:00 -0400

The Department of Health and Human Services’ continued efforts to drive transparency into the U.S. healthcare system will not wane in the concluding months of the Bush Administration. HHS Secretary Michael Leavitt, speaking at the Fifth Annual World Health Care Congress event on April 23rd in Washington, announced his intentions to proceed with the plans for change in the healthcare system with “a continued sense of urgency.” One of the initiatives that Leavitt will continue to push is the consolidation of all healthcare quality standards used across its agencies. The HHS intends to publish these standards and make them available for market-wide use. HHS is also testing an initiative involving competitive bidding for bundled services, beginning with a Medicaid demo that officials hope to expand. The value-driven healthcare plan depends on “healthcare IT adoption to record quality measures and aggregate and provide cost and quality information to consumers,” but adoption is not nearly as widespread in small physician practices as Leavitt would hope. Still, in his final 272 days left as HHS secretary, Leavitt has no intentions of slowing down his crusade for change in the healthcare system.

Some Operators Closing Retail Clinics, Scaling Back Expansion Plans --Industry News--

Thu, 08 May 2008 00:00:00 -0400

Walk-in health clinics at pharmacies, supermarkets and retailers are not doing as well as they once did according to a Wall Street Journal report, even though the numbers of such clinics have grown steadily over the past few years. There are currently 963 retail clinics in the U.S., compared with only 125 in 1995. Some retail clinic operators are starting to notice the shifting trend and scaling back. At least 69 clinics in 15 states have been closed, and others are scaling back expansion plans. Part of the problem is that financiers for many of the clinics did not appreciate how complex and costly such clinics are to operate, and patient acceptance of the clinics has been slow. Clinics have been spending a large percentage of resources on marketing to increase awareness. Some clinics, however, are still doing well. Walgreen’s, for example, plans to add 240 new health clinics this year.

Eastern and Western Medicine Come Together at New San Diego Center --Industry News--

Mon, 14 Apr 2008 00:00:00 -0400

A brand new, state-of-the-art medical facility for integrative care of arthritis and autoimmune disorders has recently opened in San Diego, California. The Institute for Specialized Medicine is the first medical center of its kind to be opened in the San Diego area. The institution was founded by Dr. Alexander Shikhman, who is also the medical director for Restorative Remedies, a newly developed nutraceutical company in San Diego. The Institute for Specialized Medicine’s main objective is to use all possible treatment methods available, including Western medicine, historic Eastern medicine, and a patient-centered approach from Europe. The facility was designed with aging Baby Boomers in mind. The institute specializes in helping people who suffer from “arthritis, inflammatory and metabolic disorders, autoimmune diseases, and immune system issues driven by foods and chronic infections.” A recent study showed that by the year 2030, the average Baby Boomer will be suffering from diabetes, cardiac disease, and arthritis. The institute has been designed to provide patients with individualized therapy programs that combine Eastern and Western medical practices for an all encompassing health treatment. The facility provides specialists in every field ranging from dieticians and nutritionists to physical therapists, from orthopedic surgeons to acupuncturists.

Sarbanes-Oxley on the Not-for-Profit Horizon --Industry News--

Tue, 01 Apr 2008 00:00:00 -0400

The Sarbanes-Oxley Act is currently setting its sights on not-for-profit hospitals to change the way they report profits and losses. This “Sarbanes Creep” is occurring at a time when focus is shifting from financial compliance to corporate compliance on issues of quality, finance, billing, coding and safety. Not-for-profit hospitals, such as Beth Israel Deaconess Medical Center in Boston, are being held accountable for including losses from bad debts and other sources as part of charity care calculations in past financial reports. While this new world of heightened scrutiny on the role of boards and corporate governance has led to changes ranging from slight to vast restructuring, nearly all not-for-profit hospital boards have taken action and are, at the very least, investigating what they must do in order to become compliant with Sarbanes-Oxley. Most agree that the Sarbanes-Oxley enforcement lodged against not-for-profit organizations will not be nearly as pervasive, costly, and time-consuming as the federal regulations against corporations and for-profit businesses, as small not-for-profits simply do not have the resources to comply with such demands.

A Team Approach to Cost Commitment --Industry News--

Tue, 01 Apr 2008 00:00:00 -0400

Hospitals across the country have been developing new techniques and methods for cutting costs while keeping the volume of patients high and avoiding rising expenses. In several cases, clinicians are turning to finance agencies for strategies to reduce labor expenses and supply chain costs. For example, Bristol Hospital in Bristol, Connecticut, recently turned to a finance company for assistance in reducing expenses without cutting FTEs while maintaining a commitment to high-quality care. So far the results have been positive, as last year Bristol saw over 2,000 more patients than in the previous year, and patient and employee satisfaction have been improving as well. A recent survey of healthcare finance specialists, HFMA’s Healthcare Finance Outlook 2008-2013, concluded that cost control is the biggest challenge facing healthcare CFOs and other executives. According to the report, labor expenses, such as salaries and benefits, make up the largest component of a hospital’s costs. This is fueled by a lack of talent (nurses and other healthcare professionals) and constantly increasing benefit costs. Managing labor and supply costs also rank among the top 10 challenges to healthcare executives, according to the report. Collaborations between healthcare facilities and financial agencies have tried to combat these challenges while primarily focusing on quality improvement. In the majority of cases, the teaming of healthcare and finance has resulted in enhanced productivity, lowered agency and overtime costs, and employee satisfaction. Effective collaborative efforts between hospital staffs and their finance departments can reduce labor costs which subsequently can enable a hospital to successfully provide high-quality patient care and augment the hospital’s bottom line.

Is the Medicine You Depend On Made in a Place You Trust? --Industry News--

Sun, 30 Mar 2008 00:00:00 -0400

In mid-March of this year, batches of a Chinese-made medicine were recalled worldwide for causing hundreds of allergic reactions and at least 19 deaths in the United States alone. The drug was a blood thinner named heparin used most commonly to prevent clots for patients during surgery or for those with heart trouble. The Food and Drug Administration discovered that some of the ingredients used to produce heparin had been contaminated with the chemical oversulfated chondroitin sulfate. This man-made drug acts similarly as the blood-thinning effects of heparin but is significantly cheaper to produce. The problem is that the F.D.A. has no regulations that require drug companies to make known where their prescription medicines are produced. The billion-dollar pharmaceutical industry obviously benefits from producing medicines in countries with lower costs. Although the heparin case is still under investigation, it is at least a possibility that a Chinese supplier replaced the heparin ingredients with the deadly but cheaper chemical in an effort to increase the total profit. As a result, patients are left with an undesired level of distrust and fear, though in many cases, as with heparin, refusing a vital treatment is simply not an option.

Women Increasingly Fill Medical Director Role --Staffing & Recruitment--

Fri, 01 Feb 2008 00:00:00 -0500

According to a survey conducted by the American College of Physician Executives (ACPE) and Cejka Search, there has been a 30 percent increase in the share of physician executive jobs held by women in the last 10 years. In 1997, 10 percent of physician executive jobs were held by women, while in 2007, that number rose to 13 percent. Many women get into physician executive positions through the medical director role. In 2007, 17 percent of medical directors were women, up from 16 percent in 2005 and 12 percent in 1997. Average pay for physician executives has also increased 7.5 percent according to the survey, from $240,000 in 2005 to $258,000 in 2007. Of the 7,796 ACPE members who received the survey, 27 percent responded to produce these results.

Accident Highlights Long Hours for Doctors in Training --Employment & Compensation--

Wed, 12 Oct 2005 00:00:00 -0400

Questions surrounding overworked residents continue to be a problem for hospitals across the country. In September 2005, an Illinois court ruled that Rush-Presbyterian-St. Luke's Medical Center was not liable for damages when a resident crashed his car following a 30-hour shift at the hospital, seriously injuring another motorist. Though the court was careful to draw a line saying that hospitals are not responsible for injuries caused by overworked physicians and residents, the Accreditation Council for Graduate Medical Education in 2003 developed standards outlining acceptable working conditions for residents in U.S. hospitals. According to the ACGME, all hospital residents are prevented from working more than 80 hours a week (calculated over a 4-week period) and more than 30 hours in a given shift and are required to have at least 10 hours between shifts and at least 1 day off a week. Yet though these standards are in place, many residents admit that they are not following regulations and working more hours than they are allowed. Other residents are complaining that the regulations prevent them from performing all of their duties sufficiently. The American Medical Student Association argues that the regulations are not restrictive enough, and the group is lobbying the federal government in order to install national regulations that are protected by law.

Reality Check for Joining a Group --Employment & Compensation--

Tue, 01 Apr 2008 00:00:00 -0400

When jumping into a practice out of medical school and residency, there are many considerations that a newly certified physician needs to consider before signing any contracts. Location is a primary concern, as any physician needs to decide if a different city or rural area would be an acceptable place to live for the next 25 or 30 years. Finding out all of the details of a practice - including financial data, doctor-physician assistant ratios, number of patients served, the potential for future salary raises and bonuses, and patient satisfaction levels - should be a major priority as well. Going into the practice during office hours can be a useful way to tell whether or not everything is going smoothly. Speaking to non-physician employees or even patients can be a great way to learn inside information about how the practice is functioning. Overall, joining a practice can turn into a serious commitment, and new physicians need to do serious research in order to determine whether the practice will be a good fit. Asking a lot of questions to several different parties is one of the best ways to accomplish this. Additionally, financial and other information on the practice can be retrieved from online databases like the Medical Group Management Association (http://www.mgma.com) and the National Society of Certified Healthcare Business Consultants (http://www.nschbc.com).

Part-Time Doctors --Employment & Compensation--

Mon, 05 May 2008 00:00:00 -0400

Results of a March survey of members of the American Medical Group Association showed that the proportion of doctors engaged in part-time work has gone from 13 percent in 2005 to 19 percent in 2007. Survey respondents included forty-three groups who gave several different reasons for requesting abbreviated schedules, including the onset of academic research or teaching (<3%), administrative or leadership duties (25%), family responsibilities including pregnancy (80%), health issues (7%), and retirement preparation (33%), along with various unrelated professional or personal pursuits (53%).

Choosing a Medical Malpractice Insurer --Physician Practice Management--

Tue, 01 Apr 2008 00:00:00 -0400

Physicians should choose carefully when selecting a medical malpractice insurer. The cheapest insurance is generally not the best, as some insurers offering inexpensive insurance in the 1990s went bankrupt, leaving doctors with little coverage. Now there are more options, including risk retention groups (RRGs), which are member-owned and allow members, who form groups based on specialty, such as physicians, to share risk by pooling resources. Members benefit from profits, which is an incentive to reduce risk. Whichever form of coverage they choose, doctors should look for corporations that are committed to managing risks and claims. Risk management and continuing education are key to making insurance efficient and has too often been overlooked by doctors in the past. Physicians should also ask about how claims are handled, whether experts and excellent attorneys are provided, and how disputes are typically settled. Physicians need to know that they will have reliable support from the company in the case of a lawsuit. Other pertinent questions involve the financial stability and AM Best rating of the company.

Physicians Reluctant to Communicate with Patients via E-mail --Physician Practice Management--

Wed, 23 Apr 2008 00:00:00 -0400

Even though most U.S. residents wish they could e-mail physicians about non-urgent medical issues such as prescription refills, lab results, and scheduled visits, less than one-third of physicians will use e-mail to communicate with patients. A 2007 study published in the American Journal of Managed Care found that patients able to use secure web contact with their physician were 7 percent to 10 percent less likely to schedule a visit and made 14 percent fewer phone calls to the physician’s office than those that did not use web contact. Physicians worry that receiving e-mail would increase their workload, put patients in danger of privacy breaches, and raise issues of legal liability if an urgent email was not replied to fast enough. In order for e-mailing to become routine, experts say that physicians must be trained in the risks of technology, confidentiality, and organization, though it is believed that it is only a matter of time before e-mail is a notable part of patient care.

Practicing Patients --Physician Practice Management--

Sun, 23 Mar 2008 00:00:00 -0400

A forum for sharing extremely personal medical information online is raising interesting questions about the future of personalized medicine. A website known as PatientsLikeMe allows users with specific medical disorders to publish measurable scientific data about their health problems in order to share experiences with other individuals suffering from similar issues. While providing a personal account of treatment options - including reactions to specific prescriptions - patients hope to help others get the best treatment available. A major concern surrounding PatientsLikeMe is that users are influenced by unscientific data. The website notes that when an individual user with A.L.S. discovered an unpublished preliminary Italian study citing lithium as a possible treatment option, some 109 users began taking the drug - with their doctors’ consent - without waiting for more serious medical research. Privileged patient data is another concern: instead of making money through advertising, the website hopes to make a profit by selling patient data to pharmaceutical companies. Though all users acknowledge this fact, there are major privacy issues at stake. Whether the website prospers remains to be seen, but users have been incredibly satisfied with their experiences thus far.

Changing Drug Labels --Physician Practice Management--

Mon, 21 Apr 2008 00:00:00 -0400

As a way to put an end to the confusion felt by some patients, certain leading pharmacy groups are demanding a change in the way prescriptions are labeled. Patients taking numerous prescription drugs at a time often complain that they are unable to identify or distinguish between the bottles and lose track of the different medications. Patients will occasionally forget what a certain medication provides, or they can confuse two drugs with similar sounding names but dangerously different purposes. This is not only a concern for patients but also for the pharmacists filling the prescriptions. According to the pharmacy groups advocating change, a prescription label should provide the “indication for use” or the reason why someone would take this medication. For example, if a patient suffers from high blood pressure and receives a prescription from their doctor, the label on the prescription should read “take for high blood pressure” or something of that nature. These simple indications would virtually eliminate any miscommunications between the doctor and the pharmacist as well as any confusion on the part of the patient. The hope is to get these changes to the labels state mandated. The American Medical Association agrees that having the indication on each label is a good thing but argues that it should be optional, not mandatory. They believe that mandatory use indications on a prescription label may violate a patient’s confidentiality agreement. Currently, patients can have the indications of use provided on prescription labels by simply asking their doctor ahead of time. Because there are no regulations for this, however, it is up to the physician to decide how the label actually reads.

Judge Strikes Down Cap on Malpractice Suit Awards --Medical - Legal Matters--

Thu, 01 May 2008 00:00:00 -0400

A Fulton County Judge decided that Georgia’s legislative cap of $350,000 for noneconomic damages in medical malpractice cases is unconstitutional because it provides too much protection for the medical profession. Due to the cap, people injured by doctors have less protection under the law than those injured by other things such as manufacturers’ products (for which there is no legal cap on noneconomic damages). The case under review involved a 60-year-old retiree who fell from a ladder and was left a quadriplegic due to injuries to his neck and spine that were missed by doctors. The $350,000 cap was approved as part of tort reforms in 2005. Another part of those reforms was struck down in 2006 when the Georgia Supreme Court ruled that defendants couldn’t decide where malpractice cases were tried. If upheld, the decision could undercut a number of the state’s tort reform laws.

Baby Boomer Time Bomb: Too Many Aging Patients, Too Few Geriatricians --Medical Specialty Focus--

Mon, 05 May 2008 00:00:00 -0400

The number of doctors specializing in geriatrics is declining. There are approximately 7,100 geriatricians in the U.S. today. That number is 22% lower than the number of geriatricians in 2000. This is related to the larger trend of the decline in U.S. medical graduates interested in family and general practice. If this decline continues, there will not be enough geriatricians to handle the 78 million baby boomers who will begin to turn 65 in 2011, and by 2030, there will only be an estimated 8,000 geriatricians, but the country will need 36,000. A lower rate of pay is the biggest thing keeping most doctors from entering the specialty. The Institute of Medicine suggested an increase in geriatric education across the board in the health care workforce and raising reimbursement for senior citizens’ care to offset the lack of the specialty. The AMA is also promoting more geriatric training and preventions of Medicare funding cuts which make the reimbursement problem worse. Medical graduates must spend an extra year of training to learn about the specialty, and that is hard to justify when those students are looking at a lack of proportionate reimbursement after they have finished training.

Canada's Health System Draws Mixed Reviews From Psychiatrists --Medical Specialty Focus--

Fri, 02 May 2008 00:00:00 -0400

In the continuing debate about socialized healthcare at the national level, psychiatrists in Canada give differing opinions about the viability of such a system. Many Canadian psychiatrists are proud of their universal coverage and are appalled that doctors in America are forced to turn away patients who are unable to pay for much-needed medical services. Psychiatrists in the Canadian system also see themselves as more autonomous than their American counterparts, as treatment options do not need approval from insurance companies or other third parties. When patients need a particular treatment, say an expensive medication, doctors in a socialized system prescribe options based on need, not financial availability. Further, with the elimination of multiple third-party providers, significant red tape is removed and billing is straightforward and standardized. While many in the field of psychiatry appreciate the Canadian system, others find the socialized system frustrating. There is a serious lack of hospital beds, to the point where patients are dying in emergency department waiting rooms or visiting the United States for care. With increased costs associated with universal healthcare, there is a substantial personnel shortage, particularly in terms of support staff. Some Canadian psychiatric hospitals have entire floors that are unoccupied because there is not enough funding to cover employee salaries. One critic of the Canadian system estimates that there is a current shortage of 26,000 doctors throughout the entire country. Some Canadian patients are forced to wait upwards of 4 months or longer for psychiatric outpatient care. With these pros and cons in mind, there is still a thriving debate about whether universal healthcare is a feasible solution to America's health care woes. From a psychiatrist's perspective, it is unclear whether or not a Canadian-style system has a future in this country.

Opening of Nation’s 2nd Depression Center Gets National Network Under Way --Medical Specialty Focus--

Wed, 16 Apr 2008 00:00:00 -0400

Inspired by cancer centers and heart centers across the United States, a new wave of medical centers is developing to deal with depression, bipolar disease, and other psychiatric diseases. The Depression Center at the University of Colorado Denver School of Medicine will open in August and will stand alongside the University of Michigan Depression Center, the nation’s only other depression facility. Both institutions hope to form a national network as other centers are built in the future. Work at the Colorado center will focus on treatment options, research, and education surrounding what the World Health Organization calls “one of the most disabling human illnesses.” With donations as large as $13 million from a variety of individuals and organizations, the Colorado center hopes to live up to its ambitious mission statement: “To improve the quality, effectiveness, and availability of depression and bipolar diagnosis, treatment, and prevention so patients can lead better lives.”

Experts Predict Trouble for Providers under Medicare Billing Crackdown --Payer & Reimbursement Issues--

Thu, 24 Apr 2008 00:00:00 -0400

Coding experts claim those who do not prepare for the upcoming federal crackdown on Medicare billing could be facing a number of serious consequences including six-figure bills, referrals to fraud enforcers, and even possible jail time. The Centers for Medicare and Medicaid Services will be looking at the nation’s errant Medicare billing beginning this fall. In 2006, Recovery Audit Contractors (RAC) recovered over $304 million, and the CMS intends to continue the audits based on this success. Admittedly, audits are not conducted on an unbiased basis, but compliance is the recommendation of seasoned professional billing coders. The CMS are predicted to “have a field day” when the audits begin. The offered advice is to listen to coders, not billing and records software, and document properly in order to avoid being a target. Experts say to watch billing profiles and not to cluster around one level of a code. The new RAC program is capable of asking doctors and hospitals to provide documentation for Medicare billing as far back as 2007. The Ohio State University Medical Center is already in preparation for these audit requests, having put together a task force of doctors, hospital managers, IT experts, and others to help with the audit letters, which could be delivered several times per week. A private audit would allow a hospital time to find documentation errors and possibly correct them with Medicare before the RAC audits begin. In addition, health care providers who find their own errors and report them ahead of time will have a better opportunity to negotiate the associated fines.

Insurers Rush to Fill States’ Medicaid Needs --Payer & Reimbursement Issues--

Tue, 01 Apr 2008 00:00:00 -0400

Medicaid managed care programs are much better now than they were in the 1990s. Now plans are attempting to expand Medicaid business, and states are placing more and more patients in managed care to control costs. Aetna showed an interest in Medicaid as a means for growth in August 2007 when it acquired Schaller Anderson, a Medicaid-focused company with more than 600,000 enrollees. Medicaid generates a good deal of business, with more than 45 million active members and federal and state governments spending more than $310 billion on the service. Managed care contracts between governments and health plans can be set up in several different ways, and there are more than 300 managed care plans in the U.S. Pure plays, which are “multistate, investor-owned Medicaid-only” programs, have grown particularly in recent years. These programs include those offered by AmeriGroup, Centene, Molina, and WellCare. In 2006, those companies had 1.5 million new members due to managed care expansion in Georgia, Ohio, and Texas. The push to convert Medicaid recipients to managed care is coming from both for-profit and not-for-profit plans. In 2006, 40 percent of all Medicaid members were in comprehensive plans. In spite of this growth, problems have come up in the relationships between state governments and the plans. JAMA produced a study in October of 2007 stating that Medicaid managed care enrollees do not receive the same level of care quality that is received by commercial managed care enrollees, but these findings have been somewhat disputed, and states’ monitoring of the plans can make a big difference in meeting performance requirements.

Congress Passes Bill to Bar Bias Based on Genes --Payer & Reimbursement Issues--

Fri, 02 May 2008 00:00:00 -0400

A bill recently passed by Congress will grant privacy protection for individuals who undergo genetic testing as a predictor of certain medical conditions. With a 95 to 0 Senate vote and a 414 to 1 House vote, Congress has recognized that genetic discrimination is a major obstacle to making genetic testing a mainstream reality for health care. Doctors involved in genetic testing of ordinary citizens have been complaining that many patients are fearful that if their insurance company receives indication that they are more likely to contract a certain disease, their rates will increase. For the thousands of Americans at risk for genetic disorders - conditions like breast and colon cancer, diabetes, and heart disease - this prevents them from receiving adequate medical care to catch these ailments in the earliest stages. The Genetic Information Nondiscrimination Act specifically prohibits insurance companies from raising premiums or denying coverage to any individual who is genetically predisposed to any medical condition. The bill also includes a fine of up to $300,000 for any employer who makes hiring, firing, or compensation decisions based on genetic information. There are still many difficult ethical and legal questions surrounding genetic testing, but Congress's recent vote is the first step in clearing up some of the ambiguity associated with this potentially groundbreaking technology.

U.S. Report Finds Sluggish Increases in Quality of Care --Credentialing, Licensure, Quality Management--

Mon, 28 Apr 2008 00:00:00 -0400

According to the fifth annual Agency for Healthcare Research and Quality’s report, the rate of health care quality improvement has slowed dramatically. The report is compiled of federal and state data on more than 200 quality metrics. For the report, the AHRQ compared overall rates of quality improvement and costs and examined progress versus expenses for conditions such as heart disease, cancer, and diabetes mellitus. Other efficiency metrics considered in the report included “trend data on the number and cost of potentially preventable hospitalizations and hospital costs per patient admission.” According to the report, overall quality at healthcare facilities is improving but is improving at a pace that is frustratingly slow. One suggestion as to why quality care is improving at such a slow rate is a recent hike in cost cutting, though many experts argue that there is no meaningful correlation between cutting costs and improved quality of care because the current reimbursement system is founded in volume. In order to attain more significant changes, a much larger, coordinated systems approach must be collaboratively instilled. This would readjust the reimbursement model and give physicians and other healthcare professionals the additional time needed to provide quality care. A move to adopt successful quality systems from other professional industries is beginning to gain momentum in health care.

Disciplinary Action against Physicians Dropped 6% from 2006 to 2007, US Report Finds --Credentialing, Licensure, Quality Management--

Thu, 24 Apr 2008 00:00:00 -0400

State medical boards’ disciplinary action against physicians declined for a third year in a row, decreasing by 6% in the U.S. from 2006 to 2007, according to a report by Public Citizen, cited in the Los Angeles Times. The report states that the rate has fallen 22% since 2004. The group also ranks states by dividing the number of disciplinary actions by the number of licensed physicians in the state. The state with the highest rate of disciplinary action was Alaska, with 8.33 actions per 1,000 physicians, and the lowest was South Carolina, with 1.18 actions per 1,000 doctors. According to the report’s author, more funding, staffing, and investigations are necessary to discipline physicians adequately and claimed that the report is proof that too many states allow doctors to endanger patients’ well-being because they do not sufficiently discipline the physicians.

HHS Seed Money Helps Build Health-Information Networks --Healthcare Technology--

Fri, 18 Apr 2008 00:00:00 -0400

This March, the U.S. Department of Health and Human Services pledged $22.5 million to 9 different health information exchanges (HEIs) to test the feasability of a national online health information network. Specific medical information on each patient will be distributed between the networks in hopes of making all data available whenever and wherever it is needed. Additionally, up to 1,200 physicians across each of the systems will be given the resources to store patient data using electronic medical records (EMRs). Over the 5-year period, payouts will average about $58,000 per physician or $290,000 per practice. Other health organizations and agencies are also working hard to make a national health information network a reality.

New Plan to Insure Almost All Americans in 2008 Would Save $1.6 Trillion Over 10 Years --Industry News--

Wed, 14 May 2008 00:00:00 -0400

Commonwealth Fund researchers have created a plan that would insure 44 million of the estimated 48 million uninsured Americans in 2008 and save approximately $1.6 trillion over the next 10 years. The plan is expected to cause minimal disruption for people satisfied with their current coverage, says the Commonwealth Fund, and any decisions to switch to the new coverage would be voluntary. Reports indicate financial savings would only be possible if coupled with efforts to reform how the United States pays for health care, investment in better information systems and the adoption of initiatives to improve public health. As detailed by the article, the approach calls for: -A national entity known as a “connector” that would offer individuals and small businesses a choice of private plans or a Medicare Extra plan. -The requirement that all applicants be given health insurance at standardized rates regardless of their health status. -Tax credits to make sure premiums are affordable. Premium assistance would be available to ensure that premiums do not exceed 5 percent of income and 10 percent of income for higher-income tax filers. -The expanding of Medicaid and SCHIP to cover all low-income adults and children below 150 percent of the federal poverty level with modest copayments for health care services and no premiums. -The requirement that everyone enroll in a health insurance plan - including uninsured individuals who file taxes, who would be automatically enrolled. -The requirement that employers either provide health insurance or pay 7 percent of payroll (up to $1.25 an hour) into a pool to help finance coverage. -Reforms that would extend Medicare extra benefits to current Medicare beneficiaries, eliminate the two-year waiting period for Medicare for the disabled and allow adults age 60 or older to buy into Medicare.

The Picture of Healthcare --Industry News--

Sun, 01 Jun 2008 00:00:00 -0400

With the American healthcare system generally agreed upon to have come to a crisis point, the topic is virtually inescapable in political discussions of recent. As 2008 is an election year, opinions on how to solve America’s healthcare woes are numerous and conflicting. An article in the May-June issue of Unique Opportunities takes a look at some of the options and opinions that make up the American discussion. The article cites a survey by medical software firm Epocrates, Inc. from June of 2007 which found that 80% of respondents said healthcare reform was likely to be a central issue of discussion in the 2008 election. 50% of primary care physicians said that a single payer solution was the best answer to America’s healthcare woes. 60% of those said that the state of healthcare was likely to get much worse over the coming five years. The outlook among young doctors was even worse, with 32% of those responding that American healthcare would reach an even lower state. Opinions vary, however, as to how to deal with the crisis. While some doctors advocate a single payer system, others advocate increased access to health insurance with government assistance. Still others call for a decrease in government involvement, citing regulations as the primary drivers of prices and trusting in free market powers to straighten out the mess. As is, the issue seems certain to dominate discussion in the coming election and likely for years to come beyond that.

Health Care in a Lousy Economy --Industry News--

Sun, 01 Jun 2008 00:00:00 -0400

The recent economic downturn has troubled the waters in many sectors of American life, from politics to transportation to the energy sector. But what does it mean for the health care industry? An article in the June issue of H&HN Magazine explores what the economic troubles of recent may spell out for your hospital. The author, a principal in Deloitte Consulting LLP, cites his life experience in the city of Detroit, which has experienced America’s worst economy over the last 18 months, as a reliable predictor of what to look for in the coming economy. The article goes against traditional wisdom that healthcare remains mostly unaffected by economic woes, citing the troubles of Detroit’s metropolitan hospitals as conflicting evidence. The author notes six lessons from Detroit’s situation that may be relevant across the nation as the economy worsens: -Healthcare isn’t immune to economic cycles -The payer mix changes as laid-off workers become self-payers -Patient-responsible portions of bills increase, as does bad debt -Hospital volumes drop as ER rates increase but admissions go down -Everybody expands as hospitals increase geographic reaches to make up revenues -Mergers happen quickly as hospitals join forces to survive. The downturn can, however, have some good effects. The author notes a drop in nurse vacancy rates during economic downturns as well as strong performance by regional not-for-profits. Also, costs are cut and more efficient organizations emerge when the economy finally goes back on the uptick.

Kaiser Doctors Making a Different Kind of House Call --Industry News--

Fri, 02 May 2008 00:00:00 -0400

In August of 2007, Kaiser Permanente’s Colorado division began a program in which physicians join sales associates on sales calls and follow up meetings with current members to address questions related to medical care and to “put a face” on Kaiser’s services. As an MCO, Kaiser Permanente is focused on expanding the number of services offered to each member as much as they are on courting new members outright. Based on early evidence, it appears that the biggest impact of the physician “sales ambassador” program has been the encouragement of existing member companies to enroll more employees or sign on for more services, perhaps due to an increased level of trust. According to Kaiser, the program also causes members to focus more on care issues and less on bottom-line details. Kaiser claims that the number of employees enrolled by participating members has increased fifty percent since the start of the program. Twenty-three doctors were originally contracted to be part of the “sales ambassador team” that covers the Denver area. Each physician is expected to take part in only one or two visits per month.

U.S. Court Of Appeals Upholds FTC Decision on Price-Fixing Texas Physician Association --Industry News--

Fri, 23 May 2008 00:00:00 -0400

Early in May, the U.S. Court of Appeals for the Fifth Circuit upheld an FTC ruling that North Texas Specialty Physicians, “an association of competing physicians and physician groups” in Fort Worth, Texas engaged in price fixing that did not result in “procompetitive efficiencies” or clinical integration. The price-fixing in question was mostly related to non-risk contracts. In 2003, the FTC charged the group with polling physicians to negotiate and establish minimum payment terms that they would accept from payors. Payors that did not agree with the group’s terms and meet the minimum fee standards were simply not allowed to engage with the group’s participating physicians. Physicians and payors were discouraged from dealing directly. The Court of Appeals ruling was made without a full market analysis because of the obvious anticompetitive implications of the practice, though the Court did ask the FTC to amend its original ruling that the group not deal directly with payors.

Hospitals Have New Options to Increase --Industry News--

Thu, 01 May 2008 00:00:00 -0400

For hospital administrators, days of cash on hand is a figure that could always stand to be increased. How quickly hospitals can pay their bills is a major factor in determining how they’re run, according to industry finance experts. It is believed that more timely payment of vendor bills would result in increased savings for hospitals as well as lowered overall healthcare costs. An article on Healthcarereview.com examines an offering from Security Capital called Vendor Insta Pay. The service allows hospitals, surgery centers, medical organizations and larger medical practices to pay vendors in full. Security Capital reimburses the vendor at the generally lower price offered for prompt payment, and then the medical organization pays Security Capital with extended terms, usually an additional 60 days. The program’s organizers claim the service adds no additional costs for practices and can be easily set up within a few days. The cost savings to hospitals, practices, and other medical organizations is being touted as a means of reducing health care expenditures for organizations and eventually patients.

As Doctors Get a Life, Strains Show --Industry News--

Tue, 29 Apr 2008 00:00:00 -0400

American medicine is undergoing a cultural revolution as young physicians intent on balancing work and family challenge the assumption that doctors should be available to treat patients around the clock. While quality-of-life issues have been long-festering for physicians, today’s medical field is more accommodating, and younger doctors’ attitudes are giving rise to different types of practice options, ranging from small, membership-based primary-care facilities to hospital-specific jobs that keep doctors on predictable schedules. At the same time, the attempt by new doctors to lead a less-pressured work life is putting additional strain on America’s healthcare system. Many are eschewing fields such as internal medicine, pediatrics and family medicine, choosing instead specialties that offer both higher pay and more predictable work hours. In family medicine, for example, hundreds of medical residency positions go unfilled every year. But competition for slots in dermatology residencies is fierce. To adapt, American medicine is drifting away from the old standard—in which a single doctor handled almost all of a patient’s needs—and toward a more team-based approach. This system includes not only multiple doctors but also more nurse practitioners and physician assistants.

Survey of Medical Schools is Critical of Perks --Industry News--

Sun, 01 Jun 2008 00:00:00 -0400

A ranking released by the American Medical Association finds that most US medical schools fail to adequately limit the perks handed out to doctors and trainees by pharmaceutical companies, with just one in seven schools receiving above average assessments regarding their conflict of interest policies. Conflict of interest policies are judged to be important for an untainted educational experience according to student advocates. The exposure to waves of advertising from pharmaceutical companies is thought to lessen the overall experience and even prove to have a negative and biasing effect on the education of future physicians. The AMA called recently for an outright banning of the free food, gifts, and educational seminars offered to students and their instructors by pharmaceutical companies. Of the 150 medical schools graded in the study, which was conducted by impartial students knowing nothing of the identities of the schools they were grading, only 7 received A’s, while 14 received B’s. Some 28 of the schools were in the process of revising their conflict of interest policies at press time.

Physician Recruitment: Are We Using Our Time and Resources Wisely? --Staffing & Recruitment--

Sun, 01 Jun 2008 00:00:00 -0400

The writer proposes the idea of “Advanced Access” scheduling and practice model as a solution to physician recruiter woes. This model uses Queuing Theory to reengineer the standard appointment scheduling system, leaving most appointment slots open for same-day-calling patients. As a result, patients are seen in a more timely manner and the system improves scheduling, quality of care, and continuity. Waits and delays are dramatically reduced. Applying the Advanced Access aesthetic to recruiting, the author recommends moving nonessential tasks from physicians to clerical staff, PAs, NPs and nurses. The same goes for recruiting tasks, ensuring a more streamlined workflow for recruiters and increased overall practice efficiency.

Neurology: Locum Tenens Specialists Meet Increasing Need --Staffing & Recruitment--

Thu, 01 May 2008 00:00:00 -0400

An article in the May issue of LocumLife explores the possibilities and opportunities for neurology specialists in the locum tenens field. Besides providing an opportunity for travel to other geographic regions, the locum path allows for practitioners to practice medicine without administrative distractions, experience different settings and practice styles, and learn new techniques, among many other benefits. The article points out the Midwest and South as areas particularly in need of neurology services. In addition to potential salaries of up to $225,000, the locum tenens profession also provides a great opening for female practitioners, especially in the neurology field. There are also a number of neurology fields in which demand is steadily on the increase: neuro-intensivists, neuro-hospitalists, neuro-rehab specialists, and more. The article advises those interested in the field to take full stock of its plusses and minuses before commitment to it. Familiarization with unique technological, record-keeping, and scheduling procedures is a must at various institutions. Preparedness for a large number of increasingly complex problems is also a necessary trait. The rewards to be reaped in the field are plentiful, however, for practitioners willing to take the plunge.

Is a Contract Needed When Leaving a Practice? --Employment & Compensation--

Thu, 01 May 2008 00:00:00 -0400

When a physician leaves a practice, voluntarily or not, it is a time of concern for all sides and may lead to liabilities that went unconsidered until too late. For doctors that are forced out, there are the basic concerns for reputation and short-term income, while physicians remaining in the practice must always worry about the impact on revenues and productivity. Nonetheless, there are many more subtle problems that often go unnoticed if the split is amicable, but that can prove a source for hostility and litigation given other circumstances. Health care attorney Vasilios Kalogredis outlines these concerns in his argument for the use of Separation Agreements any time a physician leaves a practice. While some of these concerns may be addressed in the general Partnership Agreement, it is helpful to revisit the terms or create a separate agreement altogether so that no details go unaddressed. According to Kalogredis, a proper Separation Agreement will consider and include the following elements: -The exact nature of the relationship that is ending, along with the termination date -Terms for addressing all outstanding payment issues, including bonuses or other benefits that may accrue after the physician’s departure -Likewise, terms for addressing liabilities that may accrue after the physician’s departure such as repayments to third parties or malpractice suits filed against the practice -A statement of buyout entitlement that includes all assets of the practice -Retraction of departee from debt guarantees -Agreement on prepaid expenses such as malpractice insurance that were covered by the practice -Terms of access to medical records -A “non-disparagement provision” to maintain the reputation of both parties -A non-disclosure provision. In short, it is important to consider how all financial ties and other elements of the relationship will carry over in the short term and address them with adequate clarity.

The Experience of Pay for Performance in English Family Practice: A Qualitative Study --Employment & Compensation--

Sun, 01 Jun 2008 00:00:00 -0400

The pay-for-performance scheme is bandied about as a partial solution to America’s healthcare system woes, but how effective is it in practice? The results of a recent study conducted in the English system, which has instituted such a practice, possibly yield some positive implications for any American implementation, but with a few caveats. The study, conducted by physicians at the National Primary Care Research and Development Center at the University of Manchester, explored the beliefs of physicians and nurses regarding the effectiveness of the new pay-for-performance system. The physicians surveyed 21 family doctors and 20 nurses in 22 practices across England between February and August of 2007. The semi-structured interview format was meant to elicit opinions as to the effect of the pay scheme on the quality of care delivered and attitudes brought about under the scheme. The study authors found that participants believed the financial incentives were enough to change behavior and even cause staff to achieve non-incentivized treatment targets. Their findings suggested alignment of targets with professional priorities and values results in increased enthusiasm among physicians and greater understanding of and compliance with guidelines. However, the scheme did seem to result in decreased personal and relational continuity of care as well as resentment by care team members not receiving a financial benefit from the new scheme. As such, the authors indicate that care should be taken in the implementation of any such system, in that, while increasing efficiency and improving medical outcomes, the scheme potentially raises dangerous alterations to practice cultures and morale.

Medical Doctors Attracted to Cosmetics: Physicians can earn more with lasers and Botox than primary care --Employment & Compensation--

Mon, 02 Jun 2008 00:00:00 -0400

With insurance and Medicare reimbursements dropping, many family doctors are turning to out-of-pocket services such as cosmetic surgery to make ends meet. Obstetrician-gynecologists (OB/GYNs) in particular have found they can’t rely on medical patients alone to keep their businesses profitable. Treatments ranging from Botox injections to plastic surgery are bringing in hundreds of thousands of dollars a year in additional income for some of these practices. As one doctor points out, delivering a baby involves nine months of care, a delivery, and then “waiting 21 years to see if the child will sue me.” All for between $800 and $1,600. A single vial of Botox from manufacturer Allergan, on the other hand, costs only $525 and contains enough for eight injections—a cost of $65 per shot. Patients, however, are charged around $500 per shot, a significant profit to the physician. Many patients spend $2,000 or more on a single visit and pay immediately, compared with a 30 to 90 day wait for insurance and Medicare payments. Add in procedures such as laser vaginal rejuvenation, labiaplasty, and laser hair removal and some practices are finding that treating medically ill patients simply isn’t as profitable as cosmetic work. This trend has some specialists worried that growing demand for these treatments will lead to neglect of basic OB/GYN checkups like pap smears, while others worry that physicians without specialist training will be tempted to use treatments they may not be trained in. Still, with demand for cosmetic procedures like Botox on the rise—from 1.6 million shots administered in 2002 to 4.6 million in 2007—it appears that more OB/GYNs will look to fill in their bottom line with these treatments.

Doctors Say ‘I’m Sorry’ Before ‘See You in Court’ --Medical - Legal Matters--

Sun, 18 May 2008 00:00:00 -0400

For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers. But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach. By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits. Hospitals are reporting decreases in their caseloads and savings in legal costs. Malpractice premiums have declined in some instances, though market forces may be partly responsible. At the University of Michigan hospital, for example, legal defense costs and the money it must set aside to pay claims have each been cut by two-thirds, and the time taken to dispose of cases has been halved. Similarly, the number of malpractice filings against the University of Illinois has dropped by half since it started its program just over two years ago. Some advocates argue that the new disclosure policies may reduce legal claims but bring a greater measure of equity by offering reasonable compensation to every injured patient. Recent studies have found that one of every 100 hospital patients suffers negligent treatment, and that as many as 98,000 die each year as a result. But studies also show that as few as 30 percent of medical errors are disclosed to patients, and only a small fraction of injured patients—perhaps two percent—press legal claims.

When You’re on the “Hot Seat” --Medical - Legal Matters--

Thu, 01 May 2008 00:00:00 -0400

Encounters with the tort system can be harrowing experiences, no matter what side a physician is on. Being deposed as an “expert witness,” however, carries its own class of anxieties and concerns. How will one’s testimony be interpreted? How will it be used? Will it be fully understood? Has one’s incomplete understanding of the complexities of the tort system resulted in an unfair proceeding? An orthopedic surgeon with experience in expert testimony gives helpful hints for these court appearances in the May issue of AAOS Now. The author lays out five strategies for ensuring the smoothest possible experience in testifying. -Memorize dates: A witness gains credibility by having dates memorized. At least in appearances, it accentuates the “expert” part of “expert witness”. -Pay attention to your Curriculum Vitae: Your CV will be entered into the record as evidence. It should look professional, with no errors. -Tell the truth: No equivocating, tell the truth to avoid looking like you’re hiding something. -Avoid bias: Bias, perceived or real, can be turned back on you and damage your testimony and credibility. -Exercise professional discipline: do not criticize other experts. Stick to what you know.

Malpractice Consult: Your Responsibility for No-Shows --Medical - Legal Matters--

Sun, 01 Jun 2008 00:00:00 -0400

“I felt better after I took my medicine, so I just skipped our follow-up appointment.” How many times does a doctor hear such an explanation from a no-show? Many times, the patient will be fine, but an article in the June issue of Medical Economics explains that a physician still bears responsibilities in order to assure patient safety and lack of physician liability. The article recommends informing patients why follow-up visits are important, even if they have stable conditions. Exhaustive notation of such recommendations is also advisable in order to insulate the physician from subsequent liability. The article further points out that legal trouble regarding no-shows most often arises with less than stable patients or patients with problematic diagnoses and/or treatments. For these, it is recommended that the physician fully explain the condition and its accompanying risks and necessities. The patient must be made fully aware of the necessity of the follow-up appointment for his own safety’s sake. If all else fails, the author recommends taking a proactive stance: contact patients to schedule follow-ups and remind them on the day before or day of the appointment. If all this has been done and the patient still doesn’t show, and barring any negligence on the physician’s part, it’s generally okay to consider oneself in the clear.

Mental Health Parity: At Long Last? --Medical Specialty Focus--

Tue, 01 Apr 2008 00:00:00 -0400

Signaling a shift in the nation’s attitude toward and willingness to treat mental health issues, two bills on Capitol Hill currently address the disparity between treatment plans for physical health and mental health. An article in the April 2008 issue of Managed Care Magazine addressed the significance and differences between the two bills. The two bills—the Paul Wellstone Mental Health and Addiction Equity Act of 2007 and the Mental Health Parity Act of 2007—aim to “completely end insurance discrimination against mental health and substance abuse disorders.” Of the two, the Senate version enjoys greater popularity among involved parties and, with President Bush indicating that he is more inclined to sign the Senate version, stands a greater chance of enactment. The House bill would add new regulatory requirements for providers to cover all disorders listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The Senate version would also cover all listed disorders but leave open more options to providers for degrees of coverage and treatment.

Social Networking Site for Cancer Docs: Bang or Bust? --Medical Specialty Focus--

Wed, 04 Jun 2008 00:00:00 -0400

A startup web company in Scottsdale, Arizona hopes to profit by creating an online forum where oncologists can share personal experiences in order to benefit the industry of battling cancer. MedTrust Online allows physicians to use the internet to post their successes and failures with various treatments for different types of cancer, including off-label prescriptions for many rare cases. Online discussions are tightly connected to credible medical information like peer-reviewed medical journals, clinical trial information, FDA announcements, and treatment guidelines, and the website contains a fully functional search engine. The off-label prescription component of MedTrust Online is considered the most revolutionary aspect of the forum. Pharmaceutical companies are strictly regulated in what sorts of information they can release about off-label uses for their products, despite that 60 percent of all cancer drugs are prescribed off-label, according to the Agency for Healthcare Research and Quality (AHRQ). By streamlining discussions about the variety of uses for different drugs, physicians can make better decisions about oncology treatments in substantially less time than before. The off-label component does raise some eyebrows, however, as MedTrust Online, which does not charge doctors for the use of the website, uses advertisements from big pharma as its primary revenue source. Questions about a conflict of interest may dissuade many physicians from taking full advantage of the services. Whether this will happen remains to be seen. MedTrust Online seems to be weathering the initial storm of criticism and has already teamed up with Oracle and Dell to establish a closed institutional forum for South Texas Oncology and Hematology (STOH).

Proposed Rule Would Strip Health Care Access from Millions --Medical Specialty Focus--

Thu, 22 May 2008 00:00:00 -0400

The American Academy of Family Physicians (AAFP) and six other organizations are calling on the U.S. Department of Health and Human Services (HHS) to rescind a proposed rule that could undermine access to care for millions of patients by stripping areas across the United States of their status as health professional shortage areas (HPSAs) and medically underserved areas (MUAs). HHS issued the proposed rule earlier this year in putting forth a plan to consolidate the criteria for HPSAs and MUAs into a single new methodology called the Index of Primary Care Underservice. The AAFP believes that the consolidation of HPSAs and MUAs could strip 600 areas of their HPSA status while de-designating more than 900 MUAs, creating new health care shortages and exacerbating existing ones.

Misfortune Telling: Folding Together Data to Forecast Your Patients’ Health Futures --Payer & Reimbursement Issues--

Mon, 26 May 2008 00:00:00 -0400

Health plans are trying to gauge their members’ future health problems by using health risk assessment surveys, demographic data, and past medical, pharmacy and hospital claims, and then applying some heavy math. This technique is called predictive modeling, and health plans are using it more and more to forecast medical costs rather than relying on typical insurance underwriting, which assesses risk based on an insured’s age, gender, location and (sometimes) past history. Health plans are developing predictive modeling capabilities in-house, because they (and their employer customers) figure that by anticipating and trying to prevent illness, they can avoid paying even more for care.

Hospitals Give Payers Low Marks on Image, Reputation --Payer & Reimbursement Issues--

Thu, 01 May 2008 00:00:00 -0400

Health care plans received overwhelmingly low marks from the nation’s hospitals, according to a survey detailed in the May issue of Managed Care Magazine. The survey, conducted by Davies Public Affairs, measured hospital executives’ perceptions of the nation’s largest health insurance companies. It was based on 113 interviews from executives representing more than 500—or 10%—of American hospitals. In what is certain to be at least embarrassing news for payers, the largest providers showed significant amounts of negative sentiment coming from hospital executives. United Healthcare received 91% negative reviews, while Wellpoint/Anthem, Coventry, and Cigna received 48, 35, and 48% negative marks. The results are indicative of a continuing trend in which large numbers of care providers grade companies as difficult or very difficult to deal with. An overall unfavorable rating of 41% was recorded for the payers as a whole. The only company scoring a majority positive review was Aetna, with 57% of respondents rating the company positively versus a 37% negative rating. Representatives for the payer industry were noted as saying the survey doesn’t fully reflect the positive relationships the industry maintains with hospitals not represented in the study.

Small Practice Evolution: Cash-only Medical Practices Skip the Middleman --Payer & Reimbursement Issues--

Fri, 16 May 2008 00:00:00 -0400

According to the author, many of the doctors who choose the cash-only payment model do so as a matter of personal morality, since, according to one doctor, “Third-party payments are set so low that you’re forced to run patients through the office like animals every five to 10 minutes. It’s unethical to accept contract terms that aren’t good for patients.” Furthermore, most of the cash-only doctors interviewed for this story said the current economic downturn hasn’t hurt their bottom line. Furthermore, cash-only medicine has many payoffs. Because doctors with cash-only practices typically book fewer than 20 appointments a day, they spend more time with patients. With insurers out of the picture, cash-only doctors say they’re free to do more for their patients during those longer visits. Removing the middleman also trims overhead, because cash-only practices collect virtually all their charges at the time of service and therefore don’t need a traditional billing operation that eats up six to nine percent of gross revenue.

Hospitals Look to Courts, Congress to Put the Breaks on Medicaid Cuts --Payer & Reimbursement Issues--

Thu, 01 May 2008 00:00:00 -0400

Public health systems are worried about losing massive amounts in annual revenues if two new Medicaid regulations take effect on May 25. Hospital officials are mainly concerned about two new Medicaid rules: one limits payments for public hospitals to the cost of care; another curtails payments to teaching hospitals. But a total of seven rules—estimated to trim Medicaid spending by $15 billion over five years—are drawing heat from nearly all corners. Among the regulations in dispute is one limiting payments to public hospitals and narrowing the definition of a public hospital. Another proposed rule would prohibit the use of federal Medicaid funds for graduate medical education. Hospital advocates argue that Congress has barred the Centers for Medicare & Medicaid Services (CMS) from imposing cost limits on Medicaid payments to governmental providers. The regulation also reclassifies some public hospitals to nonpublic if they do not have direct access to tax dollars. These hospitals would no longer be able to contribute to the state share of Medicaid funds, which are then matched by federal dollars. Some hospital advocates see the regulations simply as a budget-cutting maneuver, but CMS officials say the regulations will help stop abuses.

Aetna Now Scores High on Doctor Relations --Payer & Reimbursement Issues--

Thu, 01 May 2008 00:00:00 -0400

In 2003, Aetna settled massive class action litigation by medical societies claiming the managed care companies delayed and denied payments improperly and otherwise stymied doctor and hospital attempts at proper compensation. The company, among others, had a very damaged reputation. So how has the company rebounded five years later to an overall positive rating from hospitals? The Hartford Courant takes a look at the company’s efforts to redeem its image. Aetna’s outreach efforts began before the settlement. The turnaround is generally credited to Aetna’s former chief executive, who led the outreach efforts and, a physician himself, directed the attempts at addressing physician concerns. The company began giving health care professionals 90 days advance warning of changes in fee scheduling and established a physician advisory board in addition to coordinating with physicians’ groups to better understand physician concerns. Alterations to policies such as those listed above have resulted in a marked improvement in the company’s image, as seen in a recent survey which listed the company at a 57% positive rating from hospital administrators, the highest of any of the large providers. The company has recommitted itself to further improving its relationships with physicians and health care providers and closing the gap on whatever dissatisfactions still exist.

CMS Seeks to Add 9 Hospital-Acquired Conditions to No-Pay List --Credentialing, Licensure, Quality Management--

Thu, 01 May 2008 00:00:00 -0400

Centers for Medicare and Medicaid proposed to stop payment on nine conditions it says are hospital-acquired and preventable, saying the cuts in payment could save Medicare some $25 billion that was spent last year. Some hail the effort by Medicare to encourage patient safety, while others say they should wait to gauge the value and efficacy of a similar implementation of non-pay status for eight other conditions enacted last year. Under the system, hospitals cannot code and charge for the following conditions as “complicating conditions” if they are developed during the patient’s hospital stay: -Surgical-site infections after total knee replacement, laparoscopic gastric bypass and gastroenterostomy, or ligation and stripping of varicose veins. -Legionnaires' disease. -Diabetic ketoacidosis, nonketotic hyperosmolar coma, diabetic coma or hypoglycemic coma. -Iatrogenic pneumothorax. -Delirium. -Ventilator-associated pneumonia. -Deep-vein thrombosis or pulmonary embolism. -Staphylococcus aureus septicemia. -Clostridium difficile-associated disease. Critics claim the “preventability” of some conditions is questionable and that the regulations would discourage hospitals from caring for the sickest of patients, which are the ones most vulnerable to these conditions.

NY Initiative Couples Payment and Practice Reform --Credentialing, Licensure, Quality Management--

Sun, 01 Jun 2008 00:00:00 -0400

A physician-founded, physician-governed health plan now underway in New York State, it is hoped, may eventually bring about beneficial structural changes to the American health system with regards to physician payment methodology. The program links primary care practice outcomes to physician payment and is the first such program in the country. Outcomes in the study will be measured in areas of Patient Centered Care, Economic Performance, and Medical Outcomes. It is hoped that the study will lead to increased recruitment and retention of primary care physicians as well through demonstrating the efficacy and cost effectiveness of primary care as opposed to later specialized treatments.

Doctors to Provide Online Consultations in War Areas --Healthcare Technology--

Thu, 22 May 2008 00:00:00 -0400

The Center for International Rehabilitation, a Chicago-based organization, is recruiting 300 volunteer physicians to provide online consultations to doctors in war-torn areas around the world. The program, known as "iCons in Medicine," looks to use telemedicine to improve the status of healthcare in countries where there is a shortage of qualified physicians and a large number of civilian casualties. Participating doctors hope to share both their technical skills and their medical knowledge to unstable countries across the world like Iraq. From using the internet to discuss results on X-rays to giving advice on day-to-day clinic operations, the program is expected to be an innovative approach to humanitarian aid that takes full advantage of developments in communication technologies.

The State of Health Information Technology in California: Use Among Physicians and Community Clinics --Healthcare Technology--

Thu, 01 May 2008 00:00:00 -0400

A survey released by the California Health Care Foundation found that California physicians use IT more so than their peers in other states, but there is still progress to be made. Most physicians still rely on paper records and manual systems. The study—which was drawn from studies by Medical Group Management Association, Harris Interactive, Cattaneo & Stroud, the California Medical Association, Manhattan Research, and the Community Clinics Initiative, all of which were conducted between 2005 and 2007—found that the use of digital equipment in medical records keeping isn’t widespread among providers at community clinics. The study also found that over half of physicians reported they routinely have electronic access to patient test results and electronic scheduling tools. Other notable findings of the study included: -13% of medical practices use electronic health records systems -2% of independent practices and 3% of community clinics have fully installed EHR systems -EHRs were reported by nearly all physicians to result in better care -Cost is a large barrier—the biggest reported—to adoption of electronic solutions -More than a third of medical groups have at least one chronic disease registry.

Physician Survey Gauges Satisfaction with EHRs --Healthcare Technology--

Thu, 01 May 2008 00:00:00 -0400

Survey designers at the American Academy of Family Physicians recently published the results of a satisfaction survey of physicians that use electronic health records (EHRs). The survey questions addressed physician satisfaction with EHR functionality, ease of use and flexibility, support and training, cost, interoperability, security and overall satisfaction with the technology. According to one of the designers, “The best EHR for a large practice is different than the best EHR for a small practice. A lot of personal preferences and situational factors enter into an assessment of an EHR. Nevertheless, we tried to present the data in the richest form we could, and I think the results can be useful for physicians.” The three highest rated EHR systems, according to survey respondents’ “overall satisfaction,” were Praxis EMR, Amazing Charts and eClinicalWorks EMR. More than 80 percent of respondents using these systems said they were inclined to choose the same EHR again, were disinclined to return to paper recordkeeping, and believed the EHR did not cost more than it was worth. In regard to detailed functionality ratings—which measured 22 distinct functions performed by an HER—the leaders were e-MDs Chart, Praxis EMR, and Practice Partner EMR. The three EHRs with the lowest overall satisfaction and detailed functionality ratings were Cerner PowerChart Office, TouchWorks from Allscripts, and Misys EMR. The relatively small number of survey respondents for each EHR system has, as expected, drawn some criticism. The results for Praxis EMR’s top rating in overall satisfaction, for instance, were based on 12 physician responses. Meanwhile, 53 physicians assessed the EHR from Centricity (formerly Logician), which finished 9th in overall satisfaction.

Seven Reasons Google Health is Overblown --Healthcare Technology--

Wed, 21 May 2008 00:00:00 -0400

Google, Inc. recently launched its free “Google Health” service to allow patients to manage their medical records online and access relevant health information. The service also gives people the option of sharing their records with doctors and other providers. While the concept is sound, and the service’s launch has been highly anticipated for over a year, some find the actual application to be severely underwhelming and cite the Google brand name as the only reason for any potential short- term success. Furthermore, there are still some kinks that will keep “personal health records,” i.e. those created by patients, from having much of an impact on the practice of health care any time soon. -Patients are asked to enter their own information on their conditions, medications, and procedures. The process is cumbersome and error-prone. -Only 14 percent of U.S. doctors use electronic medical records in the first place, and even fewer are set up to transmit that data to a PHR like Google Health -Doctors have little reason to trust patient-entered and patient-edited information -Google Health is not covered by HIPAA regulations -The service’s third-party partners are allowed to operate under their own privacy and information-sharing regulations -Data that is input cannot be exported to alternative services -Data also cannot be easily shared with applications used by health care providers.

Exploring the Costs of Going Digital --Physician Practice Management--

Thu, 01 May 2008 00:00:00 -0400

When doctors’ offices convert over to electronic medical records (EMRs) from paper records, there are headaches of installation, implementation, and training. But in the end, according to most anecdotal evidence, offices wind up with a system that works well. Despite the growing evidence that EMR systems are greatly beneficial, it often takes doctors a long time to implement them. What is the primary reason behind this lag? Cost. Adopting an EMR is an enormous undertaking: the typical cost for a small office is around $10,000 to $40,000 for software and basic equipment with a number of additional (and often unforeseen) costs. There is also a significant direct cost of training staff how to use a new EMR system, as well as the cost of lost productivity due to time the practice takes out of the workday for training. The typical EMR system is purchased with a big upfront payment for software licenses, hardware, and other necessary items and services. Smaller ongoing charges for things like IT support, data backup and hardware repair and replacement follow. As with any other large purchase, EMR system buyers can put some money down, borrow more and pay back finance charges over time. But fairly recent technology and business developments can change an EMR system into more of a utility, with services purchased as part of a monthly bill. Such a pricing trend might not be attractive to larger practices, which may have their own IT departments and the resources to obtain most of the other necessary EMR components up front, leaving relatively small ongoing costs, but small practices may find a lower but consistent cost more attractive.

Performance Measures for Physician Practices --Physician Practice Management--

Thu, 01 May 2008 00:00:00 -0400

The measurement of a practice’s performance is an indispensable facet of physician strategy. Proper management of performance identifies areas in need of improvement and aids in resource management. As a result, informed decision making is easier and continual improvements in performance can be seen. An article in the May issue of Physician Strategy News looks at what goes into a successful performance measurement. The article notes a few caveats to be taken into account when performing a measurement: -Each practice is unique, and these idiosyncrasies must be taken into account when benchmarking one’s practice. -Benchmarking should only be carried out with the goal of producing valuable, purposeful reports. Otherwise, the process only results in busywork for the measurer and those reviewing the report. -Relevancy and brevity are essential in any presentation. -Information should be used to effect positive change in a practice. Other purposes risk damaging practice morale without achieving anything useful. For data sources, the article recommends using the AMA’s Annual Compensation and Productivity Survey and the Medical Group Management Association’s surveys. For suggested benchmarking measures, the article suggests making sure to measure a practice by: -Gross and Adjusted Fee for Service (FFS) Collections -Days in Accounts Receivable -Accounts Receivable Aging by Payor -Gross Charges -Ambulatory and Hospital Encounters, in total and per provider -Surgical/Anesthesia Cases, in total and per provider -Physician Total and Work Relative Value Units (RVUs) -Number of new patients -Operating Overhead as a % of Net Medical Revenue -Revenue and expenses per encounter.

Tough Choices Face Underserved Patients and their Physicians --Physician Practice Management--

Sun, 01 Jun 2008 00:00:00 -0400

Although blacks, Hispanics and Native Americans together comprise just under a quarter of the U.S. population and are expected to comprise more than a third by 2030, the Association of American Medical Colleges says that only six percent of currently practicing physicians are from one of these minority groups. As a result, many organizations are making a concerted effort to diversify medical occupations by diversifying medical school populations. Increasing diversity among medical school students is often linked to research showing that underserved patients may be better reached by physicians from ostensibly similar backgrounds, but for some students, that connection implies an obligation—or at least expectation—for their career track. Patients often express preference for physicians from their own race because of cultural, language, and geographic similarities. Some studies show minority physicians are more likely to return to their communities and provide care for minority and underserved populations.

Making Complementary and Alternative Medicine Mainstream --None--

Sun, 01 Jun 2008 00:00:00 -0400

While many may think of the term Complementary and Alternative Medicine (CAM) as a catch-all for medical practices that are not accepted as correct, proper or appropriate, the Committee on the Use of Complementary and Alternative Medicine by the American Public suggests that CAM is better viewed as “a broad domain of resources that encompasses health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the dominant health system of a particular society or culture in a given historical period.” ...more

Healthcare Providers’ Use of Complementary and Alternative Medicine --None--

Sun, 01 Jun 2008 00:00:00 -0400

Our monthly survey addresses a number of key questions: How familiar are most healthcare providers with Complementary and Alternative Medicine (CAM)? To what extent do they incorporate these procedures and therapies as part of their personal health program and in their own medical practice? Furthermore, do health professionals see a trend in greater awareness and acceptance of CAM as part of “standard medical care”?

Finding the Missing Link in Healing: --None--

Sun, 01 Jun 2008 00:00:00 -0400

“Total healing” involves more than merely treating physical symptoms according to standard medical care. Intuitive physicians are alert to what is taking place emotionally, mentally and spiritually within patients--who can be taught to contribute to their own inner healing. more...

Weaning Your Hospital off Medicare --Industry News--

Sun, 01 Jun 2008 00:00:00 -0400

The coming baby boomer retirement wave bears with it a wave of Medicare dependents for hospitals to deal with. Hospital administrators know well the difficulties of dealing with Medicare and, as such, may be reluctant to have business depend so greatly on them. So how to wean a hospital off Medicare? An article from HealthLeadersMedia.com explores a number of means to do just that. -The article points out that consolidation among hospitals is more likely in the coming years. For instance, the states of New York and New Jersey have both determined strategic hospital closings necessary to help certain institutions thrive with lower payment levels. This consolidation wave is not likely to be solely closures and acquisitions but also agreements to cooperate among larger and smaller institutions. Under such agreements, hospitals would share best practices, financial systems, operating agreements, referral support, and even physicians and residents. -Some forecast cuts in Medicare payouts. Faced with this proposition, some administrators actually want such cuts to occur in order to more quickly bring about solvency within the hospitals that survive the event. -The article predicts that hospitals will be less able to work over the privately insured to cover Medicare shortfalls. The decline of “cost-shifting” should be accepted sooner rather than later, as hospitals will have to shift costs to a model that doesn’t rely as heavily on private, third-party payers. -Some hospitals are expanding their offerings as a means of increasing revenues. This diversification leads institutions to focus less on acute care and more on outpatient and wellness care. -Other hospitals are focusing on quality. The proposed shift to performance-based pay has hospitals focusing more on outcomes and being at the forefront of quality service. Reduced mortality and more positive outcomes, in addition to resulting in healthier patients, will result in higher pay for physicians and hospitals. Forward-looking administrators are altering institutional policies to reflect this coming reality. -Finally, some hospitals are attempting to make patients care more about their treatment. More compliant patients—patients who follow doctors orders, show up for follow-up appointments, etc—end up placing less of a burden on the system through their healthcare choices. As a result, greater emphasis is being placed on patient education initiatives and follow ups by some hospitals.

First Medical Tourism Guidelines Issued by AMA --Industry News--

Wed, 18 Jun 2008 00:00:00 -0400

The American Medical Association adopted nine principles at its annual policy-making meeting in Chicago in order to provide the first ever guidance for patients considering traveling abroad for healthcare. According to the AMA, medical tourism is a small but growing trend in the United States, with 150,000 people heading abroad for medical procedures in 2006. Among the nine principles adopted, the AMA suggests that patients should be referred only to institutions accredited by recognized bodies such as the Joint Commission International or the International Society for Quality in Health Care. In addition, “local follow-up care should be coordinated and financing arranged to ensure continuity of care when patients return home.” Until the cost of care in the United States is effectively addressed, the AMA suggests that these principles will help to ensure that the care U.S. patients receive abroad is effective and safe.

FTC: Clinic Rules Not What Doctor Ordered --Industry News--

Sat, 14 Jun 2008 00:00:00 -0400

The FTC has deemed efforts to regulate retail clinics promoted by the Illinois State Medical Society anti-competitive and harmful to consumers. In a letter to a legislator that requested the agency’s input, the FTC indicated concern that a bill to increase regulation by requiring permits, curbing advertising plans and requiring more physician involvement would put the many retail clinics typically staffed by advanced-degree nurses known as Nurse Practitioners at a competitive disadvantage with similar healthcare facilities that are not held to the same standards. The retail clinic model has been praised by health insurers, employers and consumer groups as a way to address the national problem of access to medical care. Unlike most doctors’ practices, most clinics are open seven days a week, twenty-four hours a day. Merchant Medicine, a Minneapolis-based research and consulting firm, suggests that nearly 1,000 retail clinics exist in the U.S. This number will likely continue to grow, as bigger retailers forge ahead with further development. Doctors claim that their primary concern with the retail clinics is not loss of income, but proper patient care. It is believed that the FTC’s letter will thwart the legislation, although it is unlikely that action will be taken on the bill until November.

Debt Load --Industry News--

Sun, 01 Jun 2008 00:00:00 -0400

Uncompensated care—including both charity and bad debt—rose to $31.2 billion in 2006, approximately 5.7% of total hospital expenses for the year. The underinsured are quickly becoming as big a source of bad debt as the uninsured. As a result, hospitals are adopting some new and controversial measures to make good on invoices. A large and increasing amount of debt comes from the after-insurance portion of the hospital bill, as patients fail to pay the balances remaining after their insurance provider has paid. This has led to a push among hospital administrators to adopt front-end solutions. These include software that estimates—with the help of practice and payer histories— charges before treatment is administered, providing patients a firm number to expect after their insurance has paid its portion. Some also engage in up-front payments, with verification of coverage and payment authorizations performed before treatment is administered. Controversially, some institutions are utilizing credit scores to make decisions on payment plans and eligibility for charity care. Critics cite the possible effect of such policies on the treatment uninsured patients may receive, but proponents cite the limited application of such policies and financial straits in which hospitals find themselves today. To encourage faster payments, some institutions are making portals for online payments available to patients. Adventist Health Services expects some 10% of patient payments within its system to be online by the end of 2009, up sizably from 2.7% in 2008.

Minnesota Adopts Bill Creating Medical Homes --Industry News--

Mon, 16 Jun 2008 00:00:00 -0400

In May, Minnesota adopted a bill designed to boost preventative care through new types of physician payment, care coordination, and health information technology. Supported by the Minnesota Medical Association, the bill offers patients the opportunity to choose a medical home and provides publicly and privately funded pay for physicians to coordinate care. The care coordination payment is intended to encourage doctors to see fewer patients in their office but give better care to more patients over time by communicating with them more over phone, email, in group settings or through an office care coordinator. The e-prescribing provision requires all physicians to send prescriptions electronically by Jan. 1, 2011; however, the act does not include funds to help physicians adopt e-prescribing. The standard for qualification as a medical home is not due to be spelled out until July 2010.

Universal Healthcare Momentum --Industry News--

Sun, 01 Jun 2008 00:00:00 -0400

Continuing the trend of individual states acting to solve their healthcare woes on their own, a universal healthcare bill is making its way through the New Jersey State Senate. The first part of the bill, two years in the making, has passed the Budget and Appropriation Committee as well as the Health and Human Services and Senior Citizens Committee. Proponents look to get final passage in both houses by June 30th and begin passing the second part of the bill soon thereafter. The bill, proposed by State Senator Joseph Vitale, expands eligibility and outreach for New Jersey FamilyCare, establishes a coverage mandate for children, and reforms aspects of the individual and small employer healthcare markets. The second phase will create a state-managed, commercial grade plan for all residents of New Jersey and a collaborative care system for the remaining uninsured. The plan was assembled over two years with the aid of 20 experts in the field. It also includes reforms aimed at allowing premium differentials to young adults making up to 350% of the poverty level. People on individual plans would be protected from rate hikes limited to 15% annually. Concern expressed by physician groups point out possible spikes in healthcare utilization in underinsured areas after the passage of the bill, possibly overwhelming the health worker infrastructure in such areas. This, they warn, could result in physician migration to avoid forced participation, which would deprive already needy areas of even more healthcare workers. Proponents point to the need to address underinsured and uninsured citizen needs as overriding these concerns.

Barcode Systems to Reduce Hospital Drug Errors Not Foolproof --Industry News--

Tue, 01 Jul 2008 00:00:00 -0400

Designed to prevent drug errors in hospitals, the barcodes that are supposed to match up drugs and dosages with patients may themselves be subject to errors, according to a study performed by University of Pennsylvania researchers. The study of barcodes use in five hospitals found nurses overrode alerts indicating problems in 4.2% of patients, which accounted for 10.3% of all medications ordered. The study also found instances of inability to scan codes or correctly use them among nurses. The study monitored barcode usage in one 470-bed academic tertiary care Midwestern hospital and four hospitals that are part of a 929-bed healthcare system. The researchers shadowed nurses, interviewed staff about systems, and looked at reasons given for overrides. The study found 15 ways of working around barcodes, including duplicate patient ID bands carried on nurses’ wrists, nurses carrying numerous pre-scanned meds at once, and nurses disabling system alarms so as not to disturb patients. These opened the door for any number of medical errors. The study found valuable benefits to the use of barcodes despite these troubling flaws. The study authors counted 23,828 alerts resulting in user change rather than user override. These findings are generally in keeping with previous studies indicating deviation from protocol and human error as the primary factors in system flaws.

The Administrator’s Desk: Dealing With PTO Time --Staffing & Recruitment--

Sun, 01 Jun 2008 00:00:00 -0400

The old practice of delineating specific numbers of days for vacation, personal, and sick leave is, in some cases, giving way to a new system of Paid Time Off (PTO) hours from which employees can draw at their discretion. While easier and more flexible for employees, this can present a headache for administrators if improperly implemented. An article in Physician’s Practice examines some ways to keep PTO policies straight and your office productive. PTO presents a number of possible benefits for practices implementing such policies. PTO, for example, eliminates the administrative chore of tracking reasons for absences. In addition, it minimizes unscheduled absences on the part of employees since they no longer have to call in. In a 2007 study of business with PTO plans, it was found that illnesses account for only 34% of absences, with the vast majority made up of an assortment of personal reasons other than illness. The study also found that PTO banks are the best tool for controlling absence according to employees working under such systems. Problems are possible with the PTO model, however. Some employees, in an effort to retain as many days off as possible, may come into work sick, running the risk of infecting others. Employees also run the risk of blowing through all time off earlier in the year, leaving no time for eventualities later in the year. If an employee has run through her time off in the first half of the year and falls ill during flu season, administrators will need to add additional sick days for that employee, which can result in staffing and scheduling problems. The author recommends making sure employees are aware of this possibility and that they plan to keep at least five days in the bank in case they are needed. The article recommends striking a balance between rollover and expiring leave in order to keep employees from “squirreling” away leave hours and eventually leaving the practice short staffed for a massive vacation. As to the total amount of leave to give employees, the article suggests this figure be based on the individual needs of a practice. It is not uncommon for employees to have 14 days of leave in their first year and up to 27 days leave depending on how long they have worked with the practice. Policies should be structured with the dual goals of presenting a positive recruiting tool for potential employees and offering one’s staff a variety of choices for their time off.

No Cash? No Insurance? No Problem: Dermatologists Barter for Business --Employment & Compensation--

Sun, 01 Jun 2008 00:00:00 -0400

In the face of numerous clients without insurance or the ability to pay directly, some dermatologists are returning to the barter system. An article in the June issue of Dermatology Times examines the phenomenon. The system works due to the foundation put in place by International Monetary Systems’ Barter System—a nationwide network offering barter networks in 50 markets in 18 to 20 states. IMS maintains the network and manages administration of transactions. Clients pay in “barter” dollars, which are transferred by the payee to IMS, which then does the taxes and processing so the dollars are treated like real income. Barter dollars are then usable by the recipient at any participating merchant. In this manner, $300 received for a dermatology procedure can become a $250 car repair and a $50 dinner. The barter system, according to participants, allows for a number of benefits. Chief among them is an expanded clientele, as the system brings in small business owners who might not have otherwise come in due to lack of personal insurance. This can result in “free” dinners, advertising services, or any number of other services. Doctors are able to trade services with other doctors on the barter system as well, and the system on the whole is regarded as resulting in cheaper, almost wholesale priced goods purchased through barter for participants.

The Online Healthcare Marketplace: Providing Physicians with a New Revenue Stream --Employment & Compensation--

Fri, 30 May 2008 00:00:00 -0400

In June, American Well Systems will sell an online healthcare marketplace product to health plans, which will in turn brand it and make it available to their membership and provider networks. The online healthcare marketplace dissolves the two sticking points for managing fees: physicians do not need to handle co-pay retrieval because payment information has been received and checked against clearinghouse information and the eligibility of an individual’s claim has already been adjudicated before the patient can interact with the provider. Members will be able to contract providers from home; but perhaps more significantly, providers will be able to determine how much, how often and when they will provide services on the system. Providers will have access to a patient’s history and can decide to not engage with a patient if they feel uncomfortable handling the complexity of the patient’s health. To protect providers against legal suit, providers with the American Well service are covered through the Lexington Insurance Company. It is believed that this new service may allow doctors to become less attached to a particular physical spot, may enable doctors to retire earlier by providing physicians a new revenue stream, and may enable retired physicians to make some money in their retirement.

AMA Calls Physician Reimbursements Flawed --Employment & Compensation--

Tue, 17 Jun 2008 00:00:00 -0400

As part of a campaign to reduce inefficiencies in claims payments, the American Medical Association released a report on Monday, June 16th that attempted to “quantify the red tape and hassle that have sent many physicians into cash-only ‘concierge’ practices or early retirement.” According to this report, insurance companies add more than $200 billion a year to the nation’s healthcare tab by failing to properly reimburse doctors. While Medicare paid the set fee 98% of the time, outperforming commercial providers in many areas, there was a great deal of difference in the extent to which private companies paid physician’s bills. According to the report, 14% of the fees that doctors receive from insurers and Medicare are spent on the process of collecting these fees. Both the insurance providers and physicians are held responsible for administrative waste and inefficiencies; while insurance companies point to significant lag times between the provision of services and the submitting of a claim, physicians note a delay on the part of the insurance company in telling doctors that they need additional information to process a claim. The report concludes that improving the processing of medical claims could reduce the overall cost to patients. The expansion of automated and electronic claims payment is cited as an effort to this end. The AMA holds the banking industry as a model for the health industry to follow.

Medical Ethics: Patients’ Needs Versus Maximizing Income --Employment & Compensation--

Thu, 01 May 2008 00:00:00 -0400

The conflict between patient needs and practice income presents a problem for doctors as patients merit the best possible care, but doctors need to repay education debts and generally survive financially. An article in the May issue of Medical Economics examines the ethical conflicts arising between pay and proper care. With Medicaid cuts a likelihood, physicians—especially primary care physicians, who are generally paid less for equally time-consuming work—are less and less likely to take on Medicaid patients. This, the article judges, constitutes less an ethical conflict than a matter of survival. The trend is not without repercussions, however. As a consequence of fewer total doctors accepting Medicaid, those doctors still seeing Medicaid patients are likely to see more patients. Doctors may also be tempted at times to perform more tests on patients than necessary. This could result from doctors not giving up, or doctors making sure all bases are covered; but it could also stem from an attempt to boost practice income. Ethicists see this as “revenue enhancement,” which can affect referral habits as well. Physicians could wind up referring to certain clinics in order to get per-referral pay. This changes the physician-patient relationship to a solely buyer-vendor relationship and imposes risks from unnecessary interventions on the patient as well as saddling the patient or payer with unnecessary costs. This is ethically unacceptable. To save money and time, some doctors may also not inform patients and their families of experimental or costly treatments if they believe there to only be a slim chance of the treatment helping the patient. This is not viewed by the article as an ethical violation, per se, as doctors are not obliged to play hero or inform of treatments they deem futile; but to be safe, full disclosure of possible treatments is generally the way to go. Dropping, or “divorcing,” patients is another option that some doctors use as a last resort. This happens sometimes due to noncompliance, nonpayment, or inappropriate behavior on the part of the patient. The article claims there is solid ethical ground for such actions so long as the patient is provided prior notice of the “divorce,” alternative treatment recommendations, and emergency care if needed. Overzealous “divorcing to improve Pay For Performance numbers,” however, is an ethical misstep.

Posting Malpractice Payout Records Evokes Big Outcry --Medical - Legal Matters--

Tue, 01 Jul 2008 00:00:00 -0400

A move by the North Carolina Medical Board to post malpractice data met with stiff resistance from physician groups. The decision made by the North Carolina Medical Board to post malpractice payouts going back seven years on its web page was in keeping with similar decisions by 25 other states but has met with protest from doctors, hospitals, lawyers, and insurers. Critics contend that disclosure of old malpractice decisions violates confidentiality clauses in some agreements and could potentially expose patient information and the names of plaintiffs were resourceful net browsers to cross-reference doctor names with legal cases. Proponents cite the legal precedents for the posting, pointing out the lack of success of legal challenges in other states. Proponents also cite testimony from malpractice plaintiffs whose procedures were performed before the advent of such systems. These plaintiffs contend that they could have been much helped in making decisions on doctors had such information been available to them.

Boundary Concerns in Clinical Practice --Medical - Legal Matters--

Tue, 01 Apr 2008 00:00:00 -0400

In psychiatry, the ethical lines governing therapist-patient interactions are a possible stumbling block for many a therapist. Unwitting transgression of even one boundary can result in a damaged therapeutic relationship or, worse, disciplinary action. An article in Psychiatric Times examines the potential boundary minefield and offers some helpful advice on negotiating patient interactions without crossing any ethical boundaries. The author sets out the parameters of therapeutic boundaries, describing them as ill-defined at times and subject to judgment and interpretation. Boundaries depend in part on context, so even the following of a patient into a public restroom may be acceptable if done in the context of furthering the treatment paruresis and with the full consent of the patient. The article sets out the difference between boundary crossings—slight deviations from established protocol with benign results and intent—and boundary violations—full transgressions of particular ethical guidelines on the part of either the patient or therapist. Crossings, such as offering a patient a ride in inclement weather, can still be sizeable offenses if proper ethical precautions are not taken. In contrast, violations are harmful to the patient—for example, entering into a sexual relationship—and should be avoided at all costs. In the event of a violation, steps should be taken immediately to inform the necessary governing bodies of ethical lapse and redress any wrongs. The article concludes by calling for increased awareness of boundaries and their underlying issues as well as careful documentation of all patient interactions and maintenance of a low threshold for consultation.

Med Mal Case in St. Louis County Circuit Court Challenges Doc’s Privacy --Medical - Legal Matters--

Wed, 18 Jun 2008 00:00:00 -0400

A doctor charged with medical malpractice in a pending suit has challenged the plaintiff’s attorney’s attempts to gain access to records concerning the doctor held by the State Bureau of Narcotics and Dangerous Drugs, the Missouri Physicians Health Program, and the Board of Registration for the Healing Arts; specifically, drug test results and medical reports shared among the agencies. Dr. Michael Impey was disciplined by the Missouri Healing Arts Board, losing his authority to write certain prescriptions. The plaintiff’s attorney, Paul Passanante, claims that these records are relevant to the case in that they establish that the defendant was still a drug addict at the time of what his client claims was a botched colonoscopy. Passanante argues that these records are not protected by doctor-patient confidentiality as they were part of public testimony and pertain to felonious conduct. The defendant’s attorneys, lead by Robert Rosenthal, claim that such would infringe on his right to medical privilege, and that such privilege cannot be waived by testimony not provided voluntarily. They also claim that the plaintiff is trying to reach beyond the facts of the malpractice. The outcome will help determine the reach of privacy of medical information in medical malpractice suits.

Doctor Put on Hold, Hangs Up, Patient Dies --Medical - Legal Matters--

Tue, 10 Jun 2008 00:00:00 -0400

A radiologist who decided to hang up the phone and fax a report of life-threatening blood clots after being put on hold when trying to contact a patient’s doctor will be held liable for the death of the patient. Rejecting jury instruction, the Virginia Supreme Court decided that the radiologist could not blame the treating doctor for the death of Tawanda Williams by pulmonary embolism. The radiologist, Cong Le, concluded that Williams had deep vein thrombosis, a dangerous but treatable condition. After Le faxed the report, he neither attempted to contact the patient, whose contact information he had, nor attempted to call back to Kaiser. The information that Williams had a life-threatening blood condition was not acted on by her doctor, and she died six days later. The Supreme Court determined that Le was ultimately responsible for the communication problems and that this responsibility was not mitigated by the doctor’s failure to read his fax. A new trial will be held in the spring of 2009.

Private Psychiatrists Offer Free Services to Troops --Medical Specialty Focus--

Sun, 25 May 2008 00:00:00 -0400

A recent private study estimated that 300,000 troops have post-traumatic stress disorder, and including family members, the number balloons to one million. Although the members of the military and those related to them are experiencing mental health problems on a scale not seen since Vietnam, the military only has one mental health professional in uniform for every thousand troops. While the government has attempted to hire more therapists, it is believed by many that the government does not have the capacity to address the growing need for mental health services on its own. In fact, a recent report by a yearlong task force at the Pentagon concluded that the Pentagon “has neither the money nor staff to support the military and family mental health needs during peacetime, let along [sic] during war.” Thousands of private therapists have provided free services to troops in an effort to fill the void. Programs such as “Give an Hour” encourage mental health care professionals to make long-term commitments to donating free services to troops. While 1,200 people currently volunteer for this program, its head hopes to find 40,000 volunteers over the next three years. Other volunteer programs intended to promote the mental health of soldiers include “Soldier’s Project” which operates in L.A., Chicago, New York and Seattle, and the “Coming Home Project,” which is based in San Francisco.

The Crisis of Primary Care Physicians --Medical Specialty Focus--

Thu, 29 May 2008 00:00:00 -0400

As primary care loses its attractiveness as a profession due to poor compensation and plummeting job satisfaction, primary care doctors are quitting and medical students are pursuing other specialties, resulting in a dearth of primary care physicians. One primary care doctor suggests the system sets the patient and the doctor against each other by requiring primary doctors to serve too many patients; the result is that the patient feels disrespected and under-cared for and the doctor feels overwhelmed and ineffective. In a situation in which appointments are rushed and the doctor does not know her patients, “more medical errors occur and more resources are wasted as expensive tests are substituted for communication.” To amend this situation, Annie Brewster, an urgent care physician at Massachusetts General Hospital, suggests that reimbursement should be restructured in order to favor more communication, care coordination, disease prevention and chronic disease management. Rather than basing incentives on patient volume, patient incentives should be based on efficient resource use and quality outcomes. Finally, it is suggested that the role of primary care physicians should be re-envisioned to include team leader and patient advocate.

Intensivists Bring Experience to Critical Care Medicine --Medical Specialty Focus--

Sun, 01 Jun 2008 00:00:00 -0400

The Intensive Care Unit is arguably the most significant hospital section due to the constant life and death situations that occur within. Yet, the ICUs of the nation tend to be lacking in intensivists—specially trained, multidisciplinary doctors who coordinate ICU teams in a manner commonly beyond regular physicians. Studies show that the quality of care in an ICU is highly dependent on the presence of an intensivist. Still, intensivists are present in only 20% of US ICUs. This is due to the cost of an on-staff intensivist as well as a general lack of the specialists in the field. A lack of intensivists in an ICU can raise the price of ICU care, though adding them can add millions to the hospital budget. Further, numbers of intensivists coming out of medical schools have been and are expected to remain flat for some time to come. As a result, some hospitals have taken to using telemedicine to staff their ICUs with intensivists. Intensivists staff Advanced ICU Care’s ops-center and monitor ICUs around the country over the internet. For emergencies, the intensivists alert the on-site staff and issue directions for them to follow. The article contends that an intensivist presence can result in lowered predicted mortality and length-of-stay for hospitals that have them. Studies show a 40% reduction in ICU mortality and a 30% reduction in general hospital mortality in facilities with an intensivist on staff. If the length of stay reductions remain true for an institution, having an intensivist on staff could very well result in lowered costs, since the hospital ends up spending less while they keep patients around for shorter times.

The ‘Secret’ World of Prison Medicine --Medical Specialty Focus--

Sun, 01 Jun 2008 00:00:00 -0400

Physicians who work in correctional settings suggest that this occupation can be ideal for physicians with an interest in public health. First, they note that the ability to affect inmates’ health and well-being is significant. Second, providing successful health care in the jails takes stress off of other parts of the health care system, as former inmates who receive good care are less likely to use episodic care and more likely to practice preventative health care. Third, health providers in correctional facilities have the opportunity to teach behaviors that stem the spread of communicable diseases like Hepatitis C and HIV. Often, health care providers are safer than custody staff, as health care providers are viewed by inmates as sources of care. Working in a prison is not without its challenges, such as tight resources and anger from individuals who do not understand why prisoners receive health care when so many are uninsured. However, for those who value the chance to perform effective preventative medicine and are concerned with responsibility to the community, the world of correctional medicine proves a secret that many health care professionals who work within prison walls hope gets out.

CMS Needs to Improve Oversight of Supplemental Payment Programs --Payer & Reimbursement Issues--

Tue, 01 Jul 2008 00:00:00 -0400

The Centers for Medicare and Medicaid Services is doing an insufficient job monitoring payments doled out through supplements to its Medicaid program, according to a report from the U.S. Government Accountability Office. The report urges expedition of efforts to issue a rule implementing additional reporting regulations for Disproportionate Share Hospitals (DSH). This comes in light of recent and prolonged troubles for the Medicaid system—widely acknowledged to be approaching fiscal insolvency—which the GAO also says needs to better track and review state supplemental payment programs, in which states make supplemental payments to certain providers. These payments are then matched by the federal government. Supplemental payments by states amounted to $23 billion in 2006, of which $17.1 billion was for DSHs. CMS responded to the GAO recommendations by claiming that the agency is in the process of updating its reporting requirements and implementing the requested rule. No plans were reported regarding state reporting of DSH payments on a facility-specific basis.

Health Plans Look to the Internet as the Future --Payer & Reimbursement Issues--

Sun, 01 Jun 2008 00:00:00 -0400

According to one Blue Cross / Blue Shield representative, everything the healthcare giant does now has a web component. Health plans are increasingly integrating web services into their operations models. An article on StrategicHealth.com examines the ways they’re going about it. The article identifies six important drivers and trends likely to shape the future of the industry going forward: -Demand for Lower Healthcare Costs: Plans are using the internet to handle administrative tasks, reducing paperwork and transaction times. The national crisis over prices is making innovative internet cost-saving measures a must. -Growing Consumerism Movement in Healthcare: The internet is the best channel for plans to deliver information about services, costs, and data on providers. The additional services they can provide result in a product better suited to the increasingly consumer driven market, in which consumers are likely to shop around much more. -Move to Online Health Records: Health plans are taking the lead in payer-based community health records. -Increasing Transparency in Healthcare: Payers are increasingly using web info-mediaries to collect, analyze, and communicate quality outcomes and pricing data to consumers. -Interest in Pay-for-Performance Programs: Incentives such as rewarding consumers for completing online health risk appraisals and health coaching sessions are increasingly in use by payers looking to cut down on the amount doctors have to do beyond treatment and thus cut costs. -Expanding Government Influence: The government is pushing IT solutions to the healthcare crisis as much as anyone else. Payers are stepping into the leadership roles created by the government and capitalizing on the federally-funded momentum for IT solutions. The article suggests that plans, due to their nature, are uniquely suited to the virtual world. The internet lowers costs and can result in improved care and better providers. Thrivers in the coming digital world of insurance will be the companies that take advantage of the situation soon.

New Medicare Rule Ensures Access to Healthcare for Beneficiaries in Rural Areas --Payer & Reimbursement Issues--

Sun, 01 Jun 2008 00:00:00 -0400

Medicare coverage would be extended to services obtained at Rural Health Clinics (RHCs) for the benefit of rural Medicare beneficiaries under a new rule proposed by the Centers for Medicare and Medicaid Services. The proposed regulation requires RHCs to establish quality assessment and performance improvement (QAPI) programs as well as establishing requirements necessary for RHC participation. Payments to RHCs will be limited to 80% of reasonable costs minus beneficiary co-insurance and deductibles. The rule would also: -Implement requirements that the RHCs be located in non-urban areas demonstrating a shortage of healthcare workers. -Clarify commingling and resource sharing regulations. -Implement requirement of QAPI programs Further information on the rule is available in a CMS fact sheet available at www.cms.hhs.gov.

Public and Private Health Insurances: Stacking up the Costs --Payer & Reimbursement Issues--

Sun, 01 Jun 2008 00:00:00 -0400

Total medical spending for lower income citizens would be lower under public programs than under private insurance, according to a study in the June issue of Health Affairs. The study was based on analysis of the 2005 Full Year Consolidated File of Medical Expenditure Panel Survey. It examined non-elderly adults and children in families with incomes under 200% of the poverty level. The study focused on Medicaid and SCHIP-insured, uninsured, and privately insured respondents and the healthcare spending levels of those covered. The study’s major findings included: -Adults on Medicaid were more likely than privately covered individuals to be in fair or poor health, have fair or poor mental health, and have limited activity, chronic health problems, or have experienced pregnancy. -Adults with Medicare showed higher spending than privately insured individuals due to their higher likelihood of serious health conditions. The uninsured had the lowest spending levels due to less help sought. -If the average adult were covered privately instead of by Medicaid, spending would increase $1,500 per year, or 26%. Out of pocket expenditures for that same adult would increase 559%. The study’s findings indicate that low income families are better served by expanded government funded policies than by tax incentives for private policies. This would be less costly to society and the beneficiaries of the policies if enacted on either the state or national level.

Aetna, Cigna Rank Highest in Efficiency --Payer & Reimbursement Issues--

Thu, 29 May 2008 00:00:00 -0400

A national survey of health plans and their dealings with physicians issued by AthenaHealth Inc., which sells electronic business services to doctors and medical groups, ranked Aetna as the most efficient health insurance provider among 130. Aetna was found to be least likely to deny claims, quickest at resolving claims and the fastest to pay doctors. Cigna ranked second in overall performance. The lowest ranked commercial health insurers were WellPoint Inc and UnitedHealth Group Inc. The survey relied on administrative, medical policy, and financial data from 2007 from 13,000 providers. On average, in 2007, it took Aetna 27 days to reimburse physicians for their claims. UnitedHealth, on the other hand, averaged a 35 day lapse. Aetna claims that its improved efficiency is due to investments in technology and better clarification of policies with participating doctors.

Doctor Opens No-Insurance Practice --Payer & Reimbursement Issues--

Mon, 16 Jun 2008 00:00:00 -0400

In an effort to simplify the payment process, in July 2008, a family medical practice in Bangor, Maine is instituting the policy that payment is required at the time of service. While the head of the practice, Dr. Karen Hover, will help patients seek reimbursement from their insurers, she will not accept payments from Medicare, MaineCare or private insurance companies. Hover believes that billing insurance companies adds an unacceptable level of bureaucracy and expense to the medical profession. While large multi-provider practices can pay for the small army that is required to undertake this complex billing procedures, the cost of billing for solo practices can be prohibitive. Further, Hover argues that the complexity produced by the sophisticated billing arrangements detracts from care. Hover believes that streamlined fee schedules can be reassuring to the uninsured and attractive to those with high deductibles. While few doctors have opted to “drop-out” like Hover, the complexities of billing have pushed many doctors to join offices where billing is handled by a centralized staff. With the general push in the medical community away from episodic management, there is reason to believe that we will not see many doctors follow Hover’s footsteps in the future as such micro-practices are ill-equipped to provide the preferred alternative, comprehensive health management.

Ensuring—and Tracking—Physician Competence --Credentialing, Licensure, Quality Management--

Sun, 01 Jun 2008 00:00:00 -0400

Continuing Medical Education and instruction with the most up-to-date medical knowledge are essential for ensuring patients are given the best possible treatments. Recognizing this, major initiatives by professional organizations and oversight bodies look to change the certification maintenance and licensure processes to ensure that doctors keep learning throughout their careers. The American Board of Medical Specialties, the American Board of Internal Medicine, the Federation of State Medical Boards, and a number of other organizations are embarking on competency evaluation initiatives. This move comes in light of studies showing only half of patients are treated according to current best practices, along with evidence of physician performance decline over time. Licencing and certification maintenance organizations are embracing a Continuous Quality Improvement approach to Maintenance of Certification (MOC). Such an approach requires evidence of continuous learning, practice performance, and improvement in three- to five-year cycles. All 24 ABMS member boards have submitted MOC plans. The Accreditation Council for Graduate Medical Education has developed Learning Portfolio—an interactive, web-based development tool which will be mandatory. Such tools are meant to allow for physicians to distinguish themselves among their peers as well as providing a “career GPS” for participating physicians. At the same time, improvements have also been made in Continuing Medical Education. The Accreditation Council for CME released new standards for accreditation, requiring programs focus more on improving Pay for Performance and patient outcomes. Acknowledging the preexisting accreditation, certification, and licensure burdens already placed upon physicians, these groups, working in concert, have the eventual aim of reducing redundancies and streamlining the requirements of their new programs in order to place less of a burden on present and future doctors.

Networking Sites Become the New Doctors’ Lounge --Healthcare Technology--

Tue, 01 Jan 2008 00:00:00 -0500

Due to patient loads and the burdens of modern practice, doctors see less of each other all the time. Most practice in groups of five or less and rarely visit their affiliated hospitals. Still, peer-to-peer interaction is necessary for a healthy physician community. Increasingly, doctors are turning to the internet to communicate with their peers. Prominent among a new crop of physician-oriented social networking sites is Within3, a professional community for physicians, health science researchers, and other healthcare workers. The site now boasts membership from 60 different countries with members representing 125 different specialties. Forty thousand of its members are doctors, with another one to two thousand added each week. The site utilizes real-time authenticated credential-monitoring to maintain a physician exclusive community. These networks aid in community cohesion and foster consultation and collaboration, which result in projects such as WikiHealthcare, a user-editable healthcare corollary to Wikipedia. Powerful tools such as these are likely to only increase in popularity as the internet becomes more and more integrated with healthcare. The site creators claim they look to be the future of collaboration and consultation in an increasingly connected world in the years to come.

Funding is Key to Turning Govt’s IT Goals into Reality for Many Hospitals --Healthcare Technology--

Sun, 01 Jun 2008 00:00:00 -0400

The plan put forward by the Department of Health and Human Services to achieve a national Information Technology Health Infrastructure aims to provide higher quality care at lower cost and use electronic information to benefit public health, biomedical research, emergency preparedness, and overall national healthcare quality. IT pros around the nation hail the plan but with caution, warning it absolutely needs federal level funding to succeed. A report released in 2007 by the American Hospital Association reported that 97% of hospitals say the initial costs are either significant or somewhat significant barriers to adoption of an IT healthcare solution. Eighty-seven percent report that the ongoing costs following implementation would constitute a barrier. Cost is widely regarded as a primary barrier to Electronic Health Records adoption around the nation. Fifteen percent of hospitals in the U.S. have EHRs. That figure, though low, is up from 11% in 2006. The hospitals having implemented EHRs, however, are mostly large, urban, teaching hospitals with more access to capital than their smaller rural counterparts. Hospital IT pros around the country hold out hope that the next administration will seriously look at the IT proposals and adopt the funding necessary. Otherwise, they say, the plan will remain just a plan.

Seattle Startup Firm to Build Online Physician Community --Healthcare Technology--

Mon, 16 Jun 2008 00:00:00 -0400

IMedExchange plans to launch a website in June that is intended to allow physicians to openly exchange medical and business advice as well as discuss other personal pursuits. Most of the $2.5 million in funding comes from physicians; the company’s advisory network includes 225 physicians. IMedExhange’s website will compete with other online medical exchange sites such as Sermo, RelaxDoc, and Within 3. Unlike Sermo, which generates its revenue through subscription fees, IMedExchange plans to generate revenue through advertising. The company aims to sign up 75,000 physicians by 2010.

Loss of Patient Information at University Hospital Reveals Risk of Acquiring Physician Practices --Physician Practice Management--

Tue, 17 Jun 2008 00:00:00 -0400

A plastic surgeon at the University of Florida-Jacksonville who donated a computer with unsecured personal information on and digital images of his patients and then lost the data when the operating system was removed has brought the risks of acquiring physician practices into relief. Although the surgeon’s computer no longer technically belonged to him after the purchase of the practice by the University, and the University took steps to ensure compliance with the University’s privacy and security policies, the fact that he had personally acquired the computer prior to joining UF may have encouraged the mindset that the computer was “his.” In addition, years in private practice may have encouraged resistance to the university’s privacy and security policies, which do not allow the storage of personal health information (PHI) on any P.C. and which require P.C.s to be disposed of through secure methods. UF notified 2,000 of the surgeon’s patients and issued a press release describing the incident. While the family to which the surgeon donated the computer claimed they did not view the data, no “malicious intent” was found, and it is often the case that first-time offenders are retrained and allowed to continue working, the plastic surgeon ultimately resigned from the physician group and from his teaching position at UF’s College of Medicine in Jacksonville. In order to prevent such a violation from occurring again, the University has retrained the surgeon’s colleagues and staff, and policies are being reinforced throughout the wider community. No university-wide policy changes were made.

Re-Examine Your Disability Insurance Policy --Physician Practice Management--

Sun, 01 Jun 2008 00:00:00 -0400

After years of limits on disability benefits in physician’s disability policies, momentum now seems to be behind a movement to add more benefits. An article in Physician’s News Digest details some reasons physicians might want to re-examine and renew their disability policies. The article details the so-called “golden years” of the 70s and 80s, when numerous companies offered a multitude of policies with strong, occupation-specific definitions of disability, with higher purchase and payout limits as well. This changed with the advent of AIDS in the late 80s, leading companies to scale back offerings or face hundreds of millions of dollars in potential payouts. Blood and urine tests became the norm for policy approvals as well. In recent years, though, there has been a shift back towards more physician-friendly policies. Own Occ—insurance geared toward providing in the event a physician suffers an injury limiting or ending his ability to perform his medical specialty, which pays out at the same rate regardless of whether a new field is chosen—has made a comeback, with five companies now offering the option. In addition, catastrophic disability benefits—which provide additional benefits in the event of an injury that leaves a physician unable to perform basic life tasks—is also now offered by a number of companies. Companies now offer higher issue limits as well, with amounts payable per month having increased from $10,000 a few years ago to $15,000. Higher participation limits are also the norm. Disability insurance companies are now participating to a greater degree in other companies’ insurance policies. Most disability policies offer up to $15,000 per month for their own policies, but in combination with another company’s policy, the payout goes to $20,000 per month. After disappearing in the 80s as companies cut costs, true lifetime benefits are making a comeback. These will pay disability to a physician even after retirement, though exceptions exist as to payout levels depending on when the disability-causing accident occurred.

Small Practice Evolution: Making the Switch to Concierge Medicine --Physician Practice Management--

Thu, 01 May 2008 00:00:00 -0400

Seeing 3,000 patients at a single practice is, by most measures, a sign of success. So why would any doctor make moves to drastically reduce his clientele? An article in Medical Economics examines the rationale behind such an odd course of action. The article examines the practice of Pittsburgh pediatrician Scott Serbin, who shrank his practice from more than 3,000 patients to around 300, improving patient relationships and his own enjoyment of the practice in the process. Serbin fits well into a smaller market niche known alternately as Direct, VIP, Boutique, or Retainer Practice. In such arrangements, patients pay an annual fee to keep a doctor essentially on retainer for a year. As of recent, the market has remained small, as the annual fees remained outside the reach of lower and middle income families. As prices drop, however, some expect that so-called “Concierge Medicine” could eventually come to be the primary service for 80% of Americans. The model is not for everyone, though. The nature of Concierge Practice limits its viability to primary care physicians. It also favors doctors with an already installed sizeable base from which to choose clientele, though this is not necessarily a hard rule. Concierge Practitioners also need to be prepared to take a financial hit, at least initially, with 30% revenue declines not unheard of as business sorts itself out. An affinity for house calls and more personalized care is also a desired trait. In the end, such an arrangement can result in better service for the patient and increased happiness for the physician.

Concierge Medicine – A Growing Trend? --None--

Tue, 01 Jul 2008 00:00:00 -0400

Patients as consumers want the highest level of medical service they can afford. Some are willing to pay premium rates for greater access to their primary care provider and more personalized medical attention. With increasing cuts in reimbursable income, more doctors are attracted to the concept of Concierge Medicine. But, given the disparities that exist in healthcare delivery, is this such a favorable trend? Our Special Report looks at all sides of this practice management concept that is gaining more currency within the healthcare profession.

Healthcare Means Patient Cure And Customer Care–Customer Service Really Does Matter --None--

Tue, 01 Jul 2008 00:00:00 -0400

My wife was about to undergo arthroscopic surgery on her left knee at a small outpatient surgical center. Chatting about how the day might go after the surgery, I noticed the medical chart hooked to her bed. I started reading some of the medical notes, most of which I did not understand. Suddenly, a nurse pulled the chart from the edge of the bed and said, “You are not supposed to be reading that.” I thought about several things to say, but before I could say anything, the nurse hooked the chart on the other side of the bed out of my sight and walked away. She reengaged in her conversation with a doctor, openly discussing the private matters of other medical personnel and seemed very unprofessional. ...more

National Health Insurance: Could it Work in the US? --Industry News--

Tue, 01 Jul 2008 00:00:00 -0400

As the U.S. has one of the highest standards of living, is a leader in technological innovation, and spends more on health care than any other country, its citizens have reason to expect better care than what many receive. This gap between expectation and reality is effectively illustrated by a 2007 New York Times/CBS poll which, among other things, found that 61% who were uninsured did not obtain needed care effectively. More to the point, the mortality rate for the uninsured is higher than that for the insured. Compounding the problem is the fact that many have inadequate health care because they have inadequate insurance. An increasing number of employers cannot afford to offer their employees health insurance, and most individuals cannot afford to purchase health insurance out-of-pocket, which can cost more than $12,000 a year for a family. In addition, the fragmentation of the private insurer system makes for enormous administrative costs—as much as 31% of all health care expenditures. As a result, the cost of insurance continues to exceed the rate of inflation. Thanks to a lack of cost controls, Americans pay up to two times what citizens in other countries do for their prescription drugs. Cost concerns have been shown to play a large role in failure to take proper dosage or failure to renew prescriptions. The authors of this article contend that the time has arrived for national health insurance. For those unconvinced that national health insurance could work in America, they point to Medicare, which has provided quality health care to 44 million American at a mere 1/6th the administrative cost of private insurers. They also suggest community-based premiums and fee-for-service payments. Whatever strategy is pursued, we are implored to agree that our status as the only industrialized nation that does not ensure access to health care to all its citizens must change.

Grassroots Movement Grants Medical Home, Access to the Uninsured --Industry News--

Tue, 01 Jul 2008 00:00:00 -0400

While most physicians aren’t new to the idea of volunteerism, the grassroots movement Project Access is using the idea of volunteerism and collaboration within the medical community as a solution to the problem of quality and affordable health care for the nation’s 46.5 million uninsured. The movement provides a network for specialists and general practitioners who volunteer their time to partner with hospitals, pharmacies, insurers and other healthcare stakeholders to provide care for uninsured Americans. This coordinated approach, funded by the Robert Johnson Wood Foundation’s Reach Out program, helps to diminish the organizational, financial and time obstacles that have contributed to the decrease of physicians providing charity care. The program, which was launched in 1995 in Buncombe County, N.C, began by inviting the county’s 700 primary and specialty physicians to donate time to care for uninsured patients. Within the year, 70% of the county’s physicians had volunteered to help, and today 90% of the physicians in Buncombe County work with Project Access to provide nearly $12 million in medical care for the uninsured in Greater Asheville, N.C. Strong physician support such as that demonstrated by Buncombe County’s physicians has helped Project Access attract new partners and grow into a national movement. From laboratories, to hospitals, medical equipment companies, medical homes and county commissioners, Project Access has attracted involvement from all facets of the medical community throughout the nation.

Billing Enforcement Pilot Recovered Millions for Medicare, Feds Plan to Crack Down Nationwide --Industry News--

Tue, 15 Jul 2008 00:00:00 -0400

The Centers for Medicare and Medicaid Services recently reported that the federal government recovered nearly $700 million in improper Medicare payments through a recovery audit contractors (RAC) three-year pilot project in California, Florida, New York, Arizona, Massachusetts and South Carolina. The RAC report showed that 85% of the recovered overpayments were collected from inpatient hospital providers, 6% were collected from inpatient rehabilitation facilities and 4% were collected from outpatient hospital providers. The majority of the overpayment errors were due to accidental double billing and miscoded claims. Although the pilot program also discovered $37.5 million in underpaid claims to providers, the primary result of the RAC report is that providers will face “unprecedented pressure” and scrutiny from the nationwide RAC program that will leave many doctors unprepared. The nationwide program may result in the forced closing of practices for doctors who haven’t been recording their care properly, but CMS officials say that the RAC program has a limited impact on most providers – the majority of hospitals in the pilot program states faced only a 2.5% impact on their bottom line. Some critics believe that supporters of RAC have a financial incentive to find overpayments and are calling for a Government Accountability Office evaluation of the RAC program.

E-Prescription Networks to Merge --Industry News--

Tue, 01 Jul 2008 00:00:00 -0400

In an effort to increase the doctors’ usage of electronic prescription technology, RxHub, which sends prescriptions to mail-order firms and provides information about insurance coverage, and SureScripts, which routs prescriptions to pharmacies, have merged to become SureScripts-RxHub. As a result of the merger, the two electronic prescription networks hope to simplify the electronic prescription process in an integrated network that connects doctors, pharmacies and benefit payers. SureScripts-RxHub plans to use this network to raise the percentage of prescriptions submitted electronically from its current proportion of 2% of 1.5 billion annual prescriptions. Additionally, Sure-Scripts-RxHub claims that electronic prescriptions will help to avoid handwriting errors and decrease the 7,000 patients who die and 1.5 million patients who are injured from prescription errors each year. Analysts hope that the e-prescription network will contribute to the creation of a national electronic health records system in the nation. The timing of the SureScripts-RxHub network coincides with governmental actions to remove barriers to the adoption of e-prescribing and electronic health records, such as weak incentives to purchase equipment, legal difficulties and privacy concerns. The proposed Congressional legislation would offer financial benefits to doctors who buy e-prescription technology. Additionally, the Drug Enforcement Agency’s proposed removal of the ban on e-prescribing some controlled substances would contribute to the speedier adoption of e-prescription technology. However, the medical community has raised concerns regarding the adoption of e-prescription technology. The American Medical Association has stated that public health insurance doesn’t cover the cost of basic health care, let alone high-tech e-prescription services. Privacy concerns regarding the transfer of patient data between company computers also exist.

PhRMA Announces Revised Code Guiding Industry Interactions With Physicians --Industry News--

Thu, 10 Jul 2008 00:00:00 -0400

In an effort to guide “the interactions between company representatives and health care professionals,” PhRMA, the Pharmaceutical Research and Manufacturers of America, strengthened its marketing code for pharmaceutical research companies’ interactions with physicians. The revised “PhRMA Code on Interactions with Healthcare Professionals” is intended to re-focus pharmaceutical and biotechnology companies’ relationship with healthcare professionals as a relationship solely for the provision of scientific and educational information and support for medical research. In order to meet this objective, the new code restricts the types of gifts and meals offered to physicians and their staff by the pharmaceutical industry to educational gifts and meals that are part of informational presentations. Meals may not be provided directly to participants at CME events. The new code also provides stricter standards regarding the nature of pharmaceutical industry interactions with health care professionals who are commercial consultants or members of the pharmaceutical companies’ speakers’ bureaus. Companies’ monetary and meal payments to health care professions must be “reasonable” and all relationships between health care professionals and pharmaceuticals must be fully disclosed.

Military Sweetens the Deal to Entice Medical Students --Industry News--

Mon, 07 Jul 2008 00:00:00 -0400

In order to combat decreased medical student enlistment in the armed services, the military is now offering a $20,000 signing bonus to its Health Professions Scholarship Program. Beginning in 2007, the Navy was the first division of the Armed Forces to offer the signing bonus, followed by the Army and the Air Force in early 2008. The Navy and Army have experienced the most dramatic declines in medical student recruitment since 2005. Speculations as to the cause for the decline in recruitment include the increased rate of female entrance into medical school, the disconnect between the current generation of medical students and World War II veterans, the war in Iraq, and the fact that the current generation of students seems to be less averse to debt than previous generations. In order to increase military recruitment through the scholarship program, which supplies 80% to 90% of military physicians, the program covers the signing bonus, tuition at any U.S medical school and any additional school-related fees. In exchange for the scholarship, students must participate in officer training during school breaks, complete a military residency and practice as a military physician for four years after school completion. In addition to the scholarship funds, the Army has begun ad campaigns, face-to-face recruiting and Internet chat rooms hosted by military physicians and residents to increase recruitment.

Effective Physician Recruitment Tools --Staffing & Recruitment--

Wed, 30 Jul 2008 00:00:00 -0400

With the nationwide physician shortage likely to continue, and with young doctors far more desirous of the amenities of a social life, the competition in recruiting doctors is as high as it has ever been. As a result, less attractive areas have a harder and harder time recruiting talent, especially rural areas. Because of this, some areas are turning to incentives as a means of ensuring a flow of talent. One method of incentivising rural practice is the exposure of first-and second-year medical students to rural life, practice, and hospitals. It is hoped that this will result in at least some students—particularly those that were raised in small towns—taking a liking to the rural lifestyle or desiring to return to a small town environment. Some states and areas are also shifting their recruiting focus to online spheres. Sixty-three percent of physician recruiters say they are working more with residency/fellowship programs and shifting their recruiting efforts to online venues. Three quarters of those recruiters represent rural areas and cities with populations under 250,000. For recruiters looking to improve their effectiveness in attracting talent, online physician job posting boards topped the list of a recent survey of recruiting practices, with 40% of respondents citing them as effective. Job posting boards were followed by physical networking and physician recruiting agencies. The digital or personal touch seems essential, as very few respondents indicated that mass marketed efforts—such as burst emails, television, and radio ads—were successful for them.

Take Your Staff From Good to Great --Staffing & Recruitment--

Fri, 04 Jul 2008 00:00:00 -0400

In the fast-changing medical community, it can be difficult for doctors to retain good employees, ensure employees are working up to their potential and adapt to the flux in staffing demands. But today’s physicians have the power to fight stagnating reimbursements and increasing costs, as outlined in a recent article with a number of recommendations for physicians to ensure that they have the “right staff doing the right things.” One way for physicians to ensure they find the right staff for their practice is to become smarter recruiters. Better recruitment techniques include the development of a clear job description with a detailed list of responsibilities and qualifications. It is also important to examine the best media approach for recruitment – depending on the market and location of the practice, print, broadcast, online or word-of-month advertising may be most effective in finding the right staff. Once qualified candidates are identified, it is essential to standardize the interview process. After the right candidates are hired, the next step towards retaining good staff is to build employee loyalty via a number of employment practices. These practices include limiting front desk personnel from duties better done by someone else, sufficient and continuous on-the-job training that orients staff to the practice and their specific job skills, rewarding achievements with positive feedback, upgrading pay whenever possible and the choosing the right number of staff to meet the needs of the practice. Although determining the right staffing levels can be difficult because practice models, patient scheduling systems, facility design, inclusion of ancillary services and technology use varies widely between practices, physician’s use of a systematic approach that compares practice performance and staffing levels with that of peers helps to determine the appropriate staffing level.

Job Sharing: Flexibility Has a Price --Staffing & Recruitment--

Tue, 01 Jul 2008 00:00:00 -0400

Job-sharing arrangements have many benefits. They have enabled doctors to balance the roles of doctor, spouse, parent and daughter or son. In addition to pro-rated benefits and other perks, job-sharers enjoy general acceptance as a full-time physician. It allows employers the opportunity to retain or hire valuable employees, offer better work coordination, and facilitate better integration with full-time staff. Despite these benefits, job sharing is far from common. For one thing, it can be difficult to pull off. The two physicians must not only have the same work ethic but also a cooperative attitude, an open communication style, flexibility and respect for the other person. In addition, job sharers require full malpractice insurance even though they are working fewer hours. For individuals who are considering pursuing a job-sharing relationship, those who have negotiated this relationship successfully offer some hints. It is recommended that you pair with someone that you know well and have worked with before. In addition, job-sharers have found that the best partner is one who is “in the same place in life at the same time,” that is, a person who can easily empathize when you may need to take extra time off. One reason for failure is different interpretation of what job sharing should entail; for instance, when one partner believes that it should entail full call responsibilities while the other believes it should only entail half. Another is different orientations toward patient care; for instance, when one partner believes that patient care should be split and the other would prefer that it be shared. While such a relationship can be difficult to navigate, for those who have been able to do so successfully, job sharing allows physicians greater control over their lives. Online resources for developing a job-sharing proposal can be found at http://jobshareconnection.com/.

Building a Physician Employment Strategy --Staffing & Recruitment--

Sun, 01 Jun 2008 00:00:00 -0400

Due to a number of factors, hospitals are increasingly hiring physicians as part of their institutional staff, but doing so without much practical experience. Physician employment is growing due primarily to economic factors. The costs of private practice are becoming increasingly stifling, with a 4-5% annual increase in staffing costs versus limited reimbursement growth. Malpractice and information technology costs are also growing while Medicare reimbursement remains either low or even shrinks year over year. In addition to the economic concerns, there is a shortage of physicians. While demand increases across the country, the supply of physicians is limited due to geographic and demographic constraints as well as the continuing increase in specialists at the expense of the primary care population. Hospitals sometimes consider physician employment in order to ensure patient access to a quality level of care for underserved populations and less attractive payer mixes. Other times, physicians are brought on as a means of attaining a strategic advantage or leverage on payers or to protect a hospital’s referral base. This also lessens dependence on private practices and shores up specialty or subspecialty ranks within a hospital, which, if the specialties are profitable, can result in an improved bottom line. In hiring full-time physicians, a number of strategies can be employed to ensure that both sides get the maximum benefit from the arrangement: -Structure deals with proper incentives. Physicians should be expected to treat a targeted number of patients, with compensation adjusted if target goals are not met. -It is difficult to have an efficiently functioning practice with only one or two doctors per location. The article cites six to eight doctors per location as an ideal number. -Hospitals should aim for at least 35% market share within their draw area to ensure better compensation rates. -The impact of taking on new practices should be fully understood by administrators. Projections of incremental revenue, costs of providing incremental care, recruitment costs, and IT are necessary. -Performance standards should be mutually agreed upon and understood by the hiring hospital and the physicians being brought on.

Enjoying the Rewards of a Locum Tenens Lifestyle --Employment & Compensation--

Tue, 15 Jul 2008 00:00:00 -0400

The locum tenens profession allows for a large amount of variety in lifestyle due to the lack of traditional restraints coming with private practice or other practice arrangements. In an article in the July issue of LocumLife, a practitioner relates his experience with the locum lifestyle, from prison practice to Bangladesh and back again. The writer, who has accepted 50 opportunities since taking up the locum tenens lifestyle, has spent the last five years between state prison facilities and Mid-Atlantic outpatient clinics. While the job is tough, the psychiatric services he provides in prisons pay well and offer a greater degree of challenge. He cites the “exemplary” relationships he’s developed with colleagues and staff as well as the enduring attachments he’s formed during each of his temporary assignments. The author further cites the flexibility of the locum lifestyle as a primary benefit. He now accepts shorter contracts with fewer workdays in order to maximize his free time. This provides him comfortable earnings plus the invaluable benefit of increased free time. This particular doctor has taken up photography, visually documenting the over 50 countries he’s visited and having shots published in such publications as National Geographic. In addition, he composes music in a self-made studio in his permanent home when in residence there. The travel and potential for free time make the writer recommend locum tenens as the perfect remedy for the practitioner weary of the nine-to-five lifestyle. The sacrifice of a bit of security can result in broadened horizons, giving a practitioner the option of his own choices, his own options, and his own preferences in practice and life.

Some Health Centers Work With Doctors’ Part-Time Needs --Employment & Compensation--

Mon, 14 Jul 2008 00:00:00 -0400

The current generation of physicians, unlike the previous 100-hour workweek generation, is looking to increase work-life balance by working part-time. Despite reports of a nationwide shortage of doctors, more doctors, particularly female physicians with families, are seeking part-time work. And as the past decade has witnessed a gender shift from the primarily male practice to an increase in the number of female practitioners – with women comprising about 53% of the incoming U.S medical student population – this trend of increased part-time work seems set to continue into the future. But it is the combined different work-level expectations of men, as well as of women, that has contributed to the increase of physicians practicing part-time, from 13% in 2005 to 19% in 2007. Of the 14,705 physicians surveyed nationwide, 12% of women and 7% of men scaled back their hours to part-time. Today, many healthcare centers are working to accommodate physicians’ desire to work part-time in their effort to retain quality physicians. However, hospitals often find themselves to be most negatively impacted by the trend because it can be hard to meet financial targets with part-time physicians.

Revisiting Physician Employment --Employment & Compensation--

Tue, 01 Jul 2008 00:00:00 -0400

As hospitals have worked to improve quality of care and patient safety in recent years, they have found a growing need for more primary care and specialty physicians. However, due largely to negative experiences in the 1990s, hospitals have been hesitant to employ new physicians. Many hospitals at the time were losing over $100,000 per physician per year thanks to complicated and expensive employment relationships. Today, physician shortages and competition in local marketplaces is leading hospitals to revisit that subject. While the experiences of the past give many hospital boards pause, employment strategies have changed significantly since the 1990s. Integrated delivery networks and lack of productivity and quality standards have given way to more adaptable and diverse systems including short-term and part-time employment as well as pay-for-performance standards and integration of physicians into hospital strategy and culture alongside the board and the administration. Hospital boards need to consider strategic alignment, market position, and likely return on investment before going forward with new employment. After this process, however, there are fortunately a number of new employment models which have helped address some of the old problems. Under the incubator model, hospitals employ new physicians short-term or part-time for a year or two while they build up referral arrangements and eventually establish their own practice. A second option is to employ physicians in the emergency department or clinic and then reimburse the physician for using their clinical expertise to build a service line. The third, and more traditional option, is simply to employ physicians for the long-term—three, four, or even up to ten years.

Too Much Variety in Pay-for-Performance Programs? --Employment & Compensation--

Tue, 01 Apr 2008 00:00:00 -0400

A new report by the health industries group at PricewaterhouseCoopers suggests that institutions are not doing enough to evaluate and track pay-for-performance (P4P) programs. Hindy Shaman, a director at PricewaterhouseCoopers says performance of these programs “has been mixed as far as the level of resources commercial plans have put in, the level of financial or nonfinancial bonus that providers get, and the amount of cost and quality tracking that payers do.” She suggests an “all-payer approach” which establishes a framework for design, quality, and reporting. The report interviewed executives from ten major commercial payers about their P4P programs.

Specialty Physician Compensation Barely Keeps Up With Inflation: Primary Care Physicians Report Nominal Pay Increases Despite Large Increase in Production --Employment & Compensation--

Mon, 14 Jul 2008 00:00:00 -0400

The Medical Group Management Associations’ Physician Compensation and Production Survey, which includes data for physicians and non-physician providers in 105 specialties and data on nearly 52,000 providers, recently released its findings regarding physician compensation. The report found that specialty physicians’ compensation remained flat in 2007 – with an increase of just 0.31% over inflation, to a median income of $332,450 a year. Among specialists, emergency medicine physicians and hematology/oncology physicians’ compensation failed to keep up with inflation, and invasive cardiologists’ compensation decreased even before inflation. Interestingly, noninvasive cardiologists’ compensation increased 11.72%, and compensation for anesthesiologists and urologists also reported gains in compensation above inflation. Primary care physicians’ compensations also fared slightly better, with a median compensation increase of 3.35% over inflation, to $182,322. The nominal increase in primary care physician compensation marks a shift in a trend of flat or declining compensation for primary care physicians. However, this increase is primarily due to primary care physicians’ 7.59% increase in production, and most physicians report that overall practice costs are continuing to increase at a fast rate – creating an uncertain reimbursement environment for physicians. The MGMA survey also noted a shift in regional trends of primary care physician compensation. In past years, physicians in the South have reported slighter higher compensation than the national median, but in 2007 primary care physicians in the West reported the highest median compensation.

Med School for Judges: A Crash Course in Medical Litigation --Medical - Legal Matters--

Mon, 28 Jul 2008 00:00:00 -0400

At the National Judges’ Medical School held at the Indiana School of Law-Indianapolis in May, more than 200 state and federal judges from 39 jurisdictions across the country were afforded the opportunity to address questions regarding complex medical cases to doctors, scientists, lawyers and fellow judges. The School, intended to equip judges with a better knowledge of medical science so that they can interpret complex health care cases, was established more than two years ago as part of a larger initiative – the Advanced Science and Technology Adjudication Resource (ASTAR) Center. In addition to the medical school, judges must follow a two-year, 120 hour curriculum after attending a “boot camp” to get up to speed with medical terminology in order to complete the ASTAR advanced science training. Preeminent in the minds of the judges and the doctors involved with ASTAR is preventing “junk science” from derailing the judicial process. At the medical school, junk science is debunked through a crash course in litigation involving medical errors. Simulated treatment conversations among doctors, a patient, a health insurance executive and a hospital ethics committee provide judges the opportunity to immerse themselves in the actual medical processes to give them an understanding of what has occurred before the case comes to court. It is hoped that if judges are trained to know what questions to ask about the credibility of an expert’s qualifications or a peer-reviewed study, they can toss out irrelevant evidence or seek another opinion from an independent, court-appointed expert. As science continues to evolve, judges are likely to see a range of novel legal issues involving public policy concerns. The 233 judges expected to complete the ASTAR advanced science training by the end of 2008 will serve as resources for fellow judges in their jurisdictions and help train the next generation of selected judges, with the goal of developing a corps of 500 specialized judges by 2010.

Why Doctors Should Worry about Preemption --Medical - Legal Matters--

Thu, 03 Jul 2008 00:00:00 -0400

Next fall, the court case Wyeth v. Levine may decide a new era for the rights of drug companies. The Supreme Court will decide whether the law implies preemption of state tort litigation with its review of the case, which concerns a patient who lost her arm after an injection of an antiemetic drug made by drug manufacturer Wyeth. If the Supreme Court sides with Wyeth, it will mean that drug companies will be protected from state-level tort litigation if their products that have been approved by the Food and Drug Administration are later found to be defective. The upcoming court case reflects the government’s shift in viewpoint from the belief that tort litigation is an important part of an overall regulatory framework that enhances patient safety to its current view that tort liability stifles product development and delays the approval process. FDA approval of a new drug does not guarantee its safety, due in part to the fact that FDA approval is primarily based on short-term rather than long-term studies. As a result, many drug safety issues become apparent only after a drug has entered the market. However, if consumers are preempted from tort litigation, the incentive for drug manufacturers to ensure product safely will be decreased, resulting in drugs and medical products that are less safe. Doctors should worry about preemption because of the potential of a negative shift in the doctor-patient relationship caused by preemption’s effect on consumer confidence in drug safety. Without the possibility of legal action in the case of unsafe drugs, doctor and patient confidence in the safety of drugs and medical products will be undermined, which may cause patients to seek other courses of treatment.

Primary Care Physicians: Get Paid for Hospital Visits --Medical Specialty Focus--

Fri, 20 Jun 2008 00:00:00 -0400

The nation’s hospitalist movement is here to stay, due to changes in the health care system such as the increased profits for health insurers and hospitals, increased productivity for primary care physicians, and the need for the constant availability of health professionals. Some worry, however, that the positive financial consequences of the hospitalist movement are mitigated by the consequences of a discontinuity in patient care and a system in which hospital-based physicians often do not have the time to build the relationship with patients that allow for individualized needs assessment and treatment. In order to address these negative aspects of the hospitalist movement, the article suggests that PCPs make regular hospital visits to interact with patients and their hospitalists to ensure the communication of all patient information. PCPs, however, are unlikely to make these visits unless insurance companies are required to reimburse them for their time. While insurers may argue that the short-term cost of primary care hospital visits would be prohibitive, it is possible that in the long-term, the coordinated continuity of care would serve as a preventative measure protecting against extraneous medical and personal costs. As it currently stands, the discontinuity between PCP and hospitalist communication does a disservice to the timely and effective treatment of patients.

Insurers Using Radiology Benefit Managers To Cut Down On Unnecessary, Costly Imaging Procedures --Medical Specialty Focus--

Wed, 30 Jul 2008 00:00:00 -0400

With medical imaging procedures costing nearly $100 billion a year in the U.S., health insurance companies have started to deny coverage for procedures that are recommended by physicians but judged by the company to be unnecessary. With costs so high and approximately half of all scans for some conditions failing to improve diagnosis or treatment, insurance companies are increasingly turning to radiology benefit managers to judge and reject unnecessary imaging procedures. Medicare has begun denying some scans and aims to cut back more. However, as Christopher Ullrich, the managed care committee director for the American College of Radiology, said, this attempt to cut costs could endanger patients: "You're going to find patients with a headache who turned out to have an aneurysm or who had abdominal pain that wasn't investigated and turned out to be a tumor.” UnitedHealth Group uses “advanced notification,” requiring physicians to notify UnitedHealth by phone, fax or the Internet before giving a patient a non-urgent scan. If the insurer suspects the procedure may be unnecessary, a UnitedHealth physician calls the prescribing physician and discusses it. Physicians who don’t notify the company risk not getting paid. A similar program used by HealthPartners has helped the company avoid 7,000 scans through computerized “decision support” integrated in the patient’s electronic health record.

Most Generalists Reluctant To Provide Primary Care For Young Adults With Chronic Illness --Medical Specialty Focus--

Wed, 30 Jul 2008 00:00:00 -0400

A new study shows that general internists and pediatricians are largely uncomfortable providing primary care for young adults with chronic illnesses originating during their childhood. The study looked at physicians treating patients with cystic fibrosis and sickle cell disease, finding that only 15% of internists would be comfortable treating a young patient with CF and 32% comfortable treating a patient with SCD. Thirty-eight percent of surveyed pediatricians said they would be comfortable serving as primary care providers for CF patients, with 35% saying the same for SCD. Both groups (internists and pediatricians) said they would be more comfortable treating common conditions such as asthma or hypertension rather than CF or SCD. While patients with these conditions are generally recommended to transfer from child-oriented to adult primary care around the age of 14, these results suggest that internists and generalists are unprepared to meet the demand for this kind of primary care. Internists, in particular, were found to be likely to worry that insufficient training would limit their ability to care for patients with these conditions, while pediatricians worried about the amount of time they could spend with the patients.

Long-Term Fix is Elusive in Medicare Payments --Payer & Reimbursement Issues--

Sun, 13 Jul 2008 00:00:00 -0400

Senator Ted Kennedy’s return to Congress in July helped the Democrats pass a bill blocking a 10.6% cut in Medicare payments to doctors. Although the bill will grant physicians an 18-month reprieve from pay cuts, it does not address the need for a long-term solution to the flawed physician fee schedule. The White House says that President Bush will veto the bill because it also proposes reductions to subsidies paid to insurance companies that care for some Medicare beneficiaries, but Democrats believe they have the needed two-thirds majority to override the veto. The Medicare payment structure is supposed to control the growth of Medicare spending for doctors’ services by linking services to the gross domestic product – a formula that works well when the economy is booming, but in the current period of recession, many doctors say that their costs are rising faster than Medicare payment rates. Under the current fee schedule, there are limits on payment for each type of service, and when actual spending exceeds the goals, payments to doctors are supposed to be reduced. Each time Congress steps in to block a cut to payment, Medicare recoups the money by making deeper cuts the subsequent year. Lawmakers are pleading with physicians to propose a comprehensive plan for a Medicare physician payment system – but such a plan is difficult to develop because it is likely to favor some types of doctors more than others.

New Issues Emerge in Healthcare Finance --Payer & Reimbursement Issues--

Wed, 09 Jul 2008 00:00:00 -0400

In the fast-changing world of health care, it is important that healthcare professionals stay up-to-date on the latest challenges in managing hospitals and healthcare system finances. The Healthcare Financial Management Association’s Annual National Institute, held this June in Las Vegas, covered a variety of the most pertinent challenges facing the healthcare system. Of primary concern were increasing numbers of underinsured and uninsured patients, ineffective pay-for-performance initiatives, the effects of new technology for hospital consolidation and demands for transparency within the medical community. Among the topics covered was the issue of hospital quality and cost-effectiveness rankings. While the rankings measure hospital quality based on “process improvements,” the rankings are less clear on outcomes, such as whether the patients got better or survived. Additionally, the rankings have no clear standard of cost-effectiveness, making it difficult for health professionals and the public to compare true cost-effectiveness between hospitals. Other areas discussed included the need for hospitals to review administrative procedures as a measure of protection against aggressive Medicare cost-recovery audits, competition for outpatient services in new healthcare fields and its effect on the increasing trend of physician-owned hospitals, and concerns about the complexity of appropriately compensating physicians at hospitals without the appearance of paying physicians kickbacks for patient referrals.

Payer Offers Patient Data on CDs --Payer & Reimbursement Issues--

Thu, 31 Jul 2008 00:00:00 -0400

Philadelphia-based Independence Blue Cross has started giving out compact discs (CDs) with patients’ clinical information about chronic conditions ranging from diabetes, heart failure, and coronary disease, to asthma and chronic obstructive pulmonary disease. Known as Smart Registries, the reports had previously been available only in hard copy, but the new electronic format allows data sorting and helps physicians identify when a patient needs certain tests, procedures, or treatments. Results are also integrated into the system. Moreover, the system records patients’ “medication persistence,” or how often they fulfill prescriptions and refills.

Getting What We Pay For: Innovations Lacking in Provider Payment Reform for Chronic Disease Care --Payer & Reimbursement Issues--

Sun, 01 Jun 2008 00:00:00 -0400

The increasing prevalence of chronic disease conditions has a detrimental effect not just on the health of the nation but on the continued escalation of health care costs. Although current physician and hospital payment methods – often based on a piecemeal approach to care delivery instead of coordinated care approach – do not promote high-quality, efficient care for those with chronic health conditions, little movement has be made to change provider payment strategies. Most of the recent efforts to improve the care of patients with chronic conditions have centered around paying disease management firms and vendors to intervene with patients and care delivery instead of reforming the underlying physician and hospital payment method problems. The most important of these barriers includes fragmented care delivery, lack of payment for non-physician providers and services supportive of chronic disease delivery, potential revenue reductions for some providers, and the lack of a viable reform champion. As the number of people with chronic conditions and related health care costs increases, the creation of a better payment system is essential to provide high quality and cost-effective care. However, it is unlikely that payment reform can occur without more support from employers and other health care purchasers. While Medicare has conducted several recent demonstrations on chronically ill patients and is planning a demonstration of a patient-centered medical home, such projects take time to evaluate. In order for lasting change to occur, it is imperative that stakeholder support and commitment to chronic condition payment change cause Congress to mandate a shift from demonstrations to the implementation of a revised payment system.

P4P Found to Have Little Impact on Care Quality --Credentialing, Licensure, Quality Management--

Mon, 04 Aug 2008 00:00:00 -0400

Pay for Performance is all the rage in political and industry discussions of recent, but does it result in improved patient outcomes? A new study suggests the scheme may have little impact at all, if any. An article from American Medical News examines the study and its implications. The study, published in the July/August issue of Health Affairs, examined 81 Massachusetts physician groups that were eligible for quality incentives and 73 that were not. The study had more access than other studies to data from a cross section of doctors and payers. The study found an overall improvement in treatment outcomes from preventive measures from 2001 to 2003, but statistically indistinguishable performance was observed among physicians regardless of compensation schemes. A number of other studies have shown results from Pay for Performance, such as a Centers for Medicare and Medicaid Services evaluation finding participating practices hitting at least 70% of quality metrics for care with P4P. The authors of the study, however, contend that their study, which takes into account control practices, represents a better model of P4P effectiveness. The article mentions the California Integrated Healthcare Association’s P4P programs: the biggest non-governmental program of its kind. An analysis of that program showed some positive effects of P4P, but these were not strong. The authors of the study as well as administrators from numerous systems contend that Pay for Performance is not an end in and of itself, but rather the first step in a restructuring, a foundation for further payment reform which they hope the system will adopt going forward.

One Answer to EMR Data: Hire a Scribe to Do It --Healthcare Technology--

Mon, 14 Jul 2008 00:00:00 -0400

One of the biggest hindrances to the use of electronic medical records is the fact that doctors are comfortable with the way they conduct examinations and take notes and do not have time to sit and enter this information electronically. Scribes, on the other hand, can be contracted to take notes of patient exams—allowing more freedom for the doctor—and reenter the information electronically in between appointments. While EMR vendors claim that practices can save money by removing the need for transcriptionists, scribe companies are actually developing a niche in support of EMR technology and could play a growing role in the future. Critics of the practice maintain that it is important for doctors to understand how EMR technology works and that the use of scribes will only delay this process.

Physicians Debate Value of ‘Most Wired Hospitals’ Survey --Healthcare Technology--

Thu, 17 Jul 2008 00:00:00 -0400

Physician IT leaders discussed the importance of the “Most Wired Hospitals” list, a ranking of hospitals based on the annual Most Wired Survey and Benchmarking Study at this July’s Physician-Computer Connection Symposium. The study, conducted by Hospitals & Health Networks magazine, ranked 556 U.S hospitals and health systems on a number of criteria, including “25 Most Improved,” “25 Most Wireless,” and “24 Most Wired – Small of Rural.” At the Symposium, physicians speculated that the ranking system might lead hospital executives to mistakenly believe that installation of technology alone increases the quality of a hospital, rather than a system of information technology carefully planned to coordinate with other medical care components. Some physicians worried that the 100 Most Wired list is used only a as a marketing tool for hospitals and suggested that the Hospitals & Health Networks survey adopt a more “Consumer Reports” approach that would not allow hospital and health system participants to use the “Most Wired” label as a marketing tool. While the adoption of information technology is important for long-term hospital improvements in efficiency, physicians suggested the need for the development of industry IT data that separates awards program from benchmarking data.

The Tech Doctor: Best-of-Breed or Integrated Systems? --Healthcare Technology--

Fri, 01 Jun 2007 00:00:00 -0400

“Should I keep my existing practice management system and interface it with my new EMR or should I purchase an integrated system that combines a new EMR with new practice management software” is a question that physicians must inevitably face. The former option, known as the “best-of-breed” approach, enables a physician to select each software application based on its inherent qualities. In addition, by allowing physicians to keep the software they have in place, it can save money and minimize disruption to the practice. However, setting up an interface can be complicated, and even with an interface, data sharing may not be as seamless as with an integrated system. On the other hand, the integrated system not only saves physicians the trouble of building an interface and likely will present fewer data exchange problems than the best-of-breed system, it also offers physicians more shared applications and allows for more sophisticated interactions between the EMR and the practice management system. If and when problems do arise, the physician benefits from the fact that there is a single point of contact for support and technical concerns. For those who choose the best-of-breed approach, a registration interface that saves staff from having to enter registration information on practice management and EMR systems separately is likely to provide the most benefit, as demonstrated by the fact that it is the most commonly chosen interface. Those who opt for the “integrated system” approach should beware that buying products from the same vendor does not guarantee that the system is integrated. In order to receive the benefits of the integrated system, the EMR and practice management systems need to share a database.

Leavitt Promotes E-Prescribing Amid Provider Concerns about Barriers --Healthcare Technology--

Tue, 22 Jul 2008 00:00:00 -0400

Health and Human Services Secretary Michael Leavitt continues to promote the launch of a nationwide healthcare information technology infrastructure—specifically electronic prescribing—despite industry and physician concerns about the financial and logistical obstacles, calling it “a top goal” of this administration. The Institute of Medicine’s figures indicate that more than 1.5 million Americans are injured each year by drug errors and that pharmacists make some 150 million calls per year to clarify illegible prescriptions. Health and Human Services, due to recent legislation, will begin rewarding providers with 2% incentives in 2009 for adoption of e-prescribing measures. The move is estimated to save Medicare $156 million over 5 years due to fewer adverse drug events. The extant incentive program has already paid out $36 million to 56,000 healthcare professionals. According to officials, providers can expect a $3,000 cost for implementation of e-prescribing technology, including training and additional fees for a data exchange line. Only 9% of the American Academy of Family Physicians report using e-prescribing, with 37% reporting that they have Electronic Health Records.

Getting Advice: How to Hire a Consultant --Physician Practice Management--

Fri, 01 Aug 2008 00:00:00 -0400

It’s hard for doctors to admit they don’t know something or need help sometimes, but many come to the realization that something is wrong in their practice: something they don’t know how to fix by themselves. To whom do you turn in these situations? An article in the July-August issue of Physicians Practice examines the best practices in finding and hiring a consultant for your practice. The continually changing landscape of the healthcare industry leaves practices open for inefficiencies that can spring up overnight. A skilled consultant can help build processes to stay abreast of these changes and keep your practice moving smoothly. The key indicators in choosing a consultant for your practice are: -Experience: Veteran consultants know their stuff. If a consultant can guess your problem without you explicitly stating it, take note of their skill and be ready to take advantage of their knowledge. -Trust through good rapport: Consultants should be able to effectively communicate not only their plans, but the rationale behind their plans. -Flexibility: Deciding on a suitable strategy for achieving important objectives may require some give-and-take. -Demonstrated ethics: Ask the candidate the usual length of client relationships and his usual terms. -Don’t be afraid to ask if your prospective consultant is accredited with the National Society of Certified Healthcare Business Consultants. -A service agreement should be clearly delineated with express terms regarding payment, services expected, and length of term. Above all, the article recommends remembering to get your money’s worth out of a consultant, but to remember that they are “paying you” at the same time with their consultation. Therefore, practices must be willing to make changes for the relationship to be worth the effort.

Physicians Issues, Economic Uncertainty, IT Major Concerns to Group Practice Managers: MGMA Survey --Physician Practice Management--

Thu, 10 Jul 2008 00:00:00 -0400

A new opinion research survey by the Medical Group Management Association asked medical group practice management professionals, physicians and members about the greatest challenges they faced while protecting their practices’ finances. The survey, conducted in March 2008, asked members who managed medical group practices to rate their level of challenge on 34 practice management and professional issues and also invited them to write their own comments. With a 12% response rate, 1,393 participants responded with over 500 written comments. Survey results indicate that the primary challenges associated with running a group practice include increasing operating costs, the financial and time costs and implementation of an electronic health record system, physician recruitment, finance management in the case of uncertain Medicare reimbursement rates, and the need to maintain physician compensation despite decreasing reimbursement.

The New Doctor-Patient Paradigm --Physician Practice Management--

Fri, 20 Jun 2008 00:00:00 -0400

Patients empowered, or at least emboldened, by Internet-based medical information and uncoupled from traditional family doctors due to shifting changes in insurance are more comfortable than ever challenging medical advice and switching doctors. This switch from the “paternalistic doctor” of the past has led to a growing discussion among physicians about their relationship with patients. While some physicians have hailed this shift, saying they learn from their patients and enjoy the more collaborative nature of the work, others worry that institutional structures like large group practices have driven a wedge between physicians and their patients. This, combined with growing skepticism and cynicism among patients, in addition to the growing threat of litigation, worries many doctors. Ahmet Ucmakli, an FP in Temeluca, CA, says that, "neither physician nor patient trust each other anymore. Owing to the intrusive effects of third-party payers, physicians are, at best, advisors; more realistically, we're waiters who take orders from patients, insurers, and administrators." The growth of HMOs and the increased paperwork associated with complex insurance policies have cut into some of the face time patients and doctors once shared, resulting in both physicians and patients feeling more rushed. And while doctors acknowledge that better-informed patients tend to have better outcomes, discussing treatment options takes far more time than a “doctor knows best” approach. Moreover, when patients find inaccurate or even dangerous information online it can undermine doctors’ advice and again prove costly. For many doctors facing these changes, patient education and openness to collaboration has proved helpful.

Small Practice Evolution: The Medical Micropractice --Physician Practice Management--

Fri, 20 Jun 2008 00:00:00 -0400

Defying practice management experts who urge doctors to increase productivity by delegating non-physician duties, the micropractice is an increasingly popular method of practice management wherein a single physician is the only employee in a small practice space. Although this minimalist approach to medicine means that micropractice doctors earn approximately 25 percent less than their peers, it also decreases overhead by 40 to 50% percent, enabling micropracitioners to increase the amount of time they spend with each patient while treating fewer patients. The idea of a micropractice is particularly appealing to younger and more idealistic doctors who see smaller practices as a way to provide a high level of care for patients while maintaining control of every aspect of the medical process. Micropractitioners feel that the small practice allows them to better accommodate and work with patients in a routine that best suits the doctor and the patient. The smaller patient load also enables doctors to make themselves more accessible to patients, even to the extent of providing a cell phone number so that the patient has an emergency contact method. However, the high level of autonomy of micropractice work requires that physicians wishing to start a micropractice must have a specific skill set – one that includes a high degree of business and information technology savvy. Before starting a micropractice, the article recommends that physicians develop a business plan with an income target and a calculation of overhead expenses, rent an office space between 100-200 square feet, acquire necessary IT software and office systems, set up a billing and collection system, and identify and eliminate insurers with cost-ineffective rates to protect finances. Although lower earnings and the continuous pace of traditional practices discourages many medical students from pursuing primary care, this trend may soon be reversed by the reports of increased contentment experienced by physicians who provide a high level of personal care to patients within the framework of a micropractice.

Reducing Administrative Costs --Physician Practice Management--

Tue, 01 Jul 2008 00:00:00 -0400

Research estimates that administrative complexity and inefficiencies raise annual health care costs by almost $300 billion, with processing medical claims alone accounting for $210 billion in raised costs. Because the complicated fee schedules, formularies, covered services, preauthorization, diagnostic and procedural coding policies vary by commercial health plan, most physicians divert approximately 14% of their revenue to ensure accurate insurance payments for their services. The standardization of physician-payer transactions and data communications between physicians and health insurers and the adoption of health information technology would help to reduce administrative burdens on physicians. The Medical Group Management Association (MGMA) lists six additional areas of administrative health care complexity most in need of simplification. These areas include the standardization of insurance product design, the creation of a single state-specific contract between payer and provider, standard state-specific billing and payment processes, standardized credentials verification, a standard physician fee schedule, and standardized clinical guidelines and disease management protocol for common conditions. In order to increase public awareness of the price of administrative complexity, the Healthcare Administrative Simplification Coalition, with the American College of Physicians, the American College of Surgeons, the American Medical Association, the Centers for Medicare & Medicaid Services and many other national organizations, have formed a campaign that highlights administrative issues in order to find solutions that will simplify the administrative process and decrease healthcare costs.

The Physician Shortage—How Critical Is It? --None--

Fri, 01 Aug 2008 00:00:00 -0400

With the health care system already in a state of crisis, some are clamoring about an oncoming shortage of physicians, just as Americans are likely to need more and better health care. What is the problem and how bad will it get? This report examines the roots of the coming shortage and what’s being done about it. Fifty-six million Americans—nearly a fifth of the country’s population—do not have a regular doctor because they live in an area without a physician, roughly equivalent to a shortage of 60,000 primary care professionals.1 This is a problem that spans the entire nation. In the panhandle and plains areas of Texas , for instance, fully 27 counties do not have a single physician. For Texas on the whole, a shortage of 4,500 doctors is projected by 2015.2 Such shortages are essentially mirrored in the national scene at large: insufficient numbers of doctors, with projections that the problem is getting worse, not better. ...more

Make the Most of Web-based Physician Recruitment --None--

Fri, 01 Aug 2008 00:00:00 -0400

Given today’s physician shortage, facilities need to use all of the tools available to them when looking to fill their key physician roles. One tool that is widely used and continues to develop is online job boards. Listed below are reports showing the growth and success in job board recruitment in increasing physician staffing. ...more

Addressing the Physician Shortage --None--

Fri, 01 Aug 2008 00:00:00 -0400

It’s predicted that by 2025, there will be a shortfall of practicing physicians in the United States totaling at least 70,000. Some hospitals and medical groups will be impacted more significantly than others. How is your facility dealing with the looming physician shortage? ...more

‘Robodoc’ Coming to a Hospital Near You --Industry News--

Thu, 14 Aug 2008 00:00:00 -0400

“Remote-presence robots,” wireless human-sized computers capable of transmitting voice and video data over long distances and controlled remotely by joysticks, are the latest approaches to the field of telemedicine, enabling doctors to evaluate patients from afar. At Pomerado Hospital in North County, CA, one such robot is employed by Dr. Ben Kanter to check on patients and to chat with patients’ family members, usually accompanied by a nurse. These robots first appeared in 2002, and the technology is now on its seventh generation. The robot is on lease from Santa Barbara-based InTouch Health and is one of 200 in use globally according to the company. Remote-presence robots are no substitute for doctors, Dr. Kanter points out, but can greatly enhance patient care. For example, a doctor at a children’s hospital may evaluate patients at other hospitals, assessing the need for transfer and recommending appropriate treatment. Hospitals without specialists on staff will find the technology useful as it enables specialists from distant hospitals to quickly evaluate patients and consult with doctors on-site. Regarding telemedicine in general, new medical education facilities are being built, equipped to train medical students in the field. Doctors, nurses, and patients alike are impressed with the new technology and have expressed interest in working with remote-presence robots.

Opinion: Is There Really a Physician Shortage? --Industry News--

Fri, 01 Aug 2008 00:00:00 -0400

With the AAMC calling for a 30% increase in medical school admissions, numerous states accrediting new medical colleges, and numerous state, federal, and industry organizations predicting shortfalls of anywhere from 80,000 to 200,000 physicians over the next fifteen years, the consensus seems clear: America faces a physician shortage which will only get worse with time. But how reliable is this consensus? An article in Contemporary OB/GYN examines the underlying evidence and posits a different conclusion. The author questions the need of even the current medical workforce. Citing stats indicating a climb in per capita physician populations of 47% from 2001 to 2010, the author says the current shortage is really more of a distribution disparity. In the past two decades, non-metro areas have had higher proportional growth in per capita physicians than have metro areas. The author states that this deficiency does not lead to adequate care, citing patient satisfaction surveys and Medicare composite quality scores indicating that per capita physician populations have little effect on quality of care. Further, he notes that rural areas have the best ratios of generalists to specialists. The author blames the shortage fears on specialty societies, whose connections to trade unions, in addition to public health concerns, lead to simplistic models of physician need adjusted for projected demographic trends. Further, the projections do not take into account the cloud of physician extenders currently saturating the marketplace. In general, the author says that concerns about a physician shortage are overblown generally and could lead to unsustainable programs, as the requested increases in enrollments and residencies will necessitate state and federal funding, and he predicts an increased physician supply will actually drive up the costs of healthcare. The author concludes that the solution is a comprehensive plan for health care access coupled with efforts to undo the disorganized and fragmented delivery system that is really at the heart of the “shortage.”

CMS Finalizes Stark Rule Changes in Final 2009 Inpatient PPS Rule --Industry News--

Thu, 14 Aug 2008 00:00:00 -0400

The Centers for Medicaid and Medicare Services released its final 2008 inpatient PPS rule on July 31, 2008. The rule includes important revisions to the Stark Regulations, including finalized revisions to the Physician’s “Stand in the Shoes” provisions and proposals to restrict “under arrangements” transactions, per unit space/equipment lease transactions, and percentage based compensation arrangements, among other regulatory aspects. -Physician “Stand in the Shoes” provisions—The final rule provides that SITS does not apply to arrangements satisfying the Academic Medical Center Exception. -Per Unit/Percentage of Revenue Leases—CMS clarified that prohibitions on “click” fees are not limited to space/equipment leases between physician-owned leasing companies and DHS entities. CMS also finalized its prohibition on percentage based compensation in space and equipment leases. -Set in Advance Requirement—CMS’ new position is that amendments to compensation terms between a DHS entity and a physician or physician organization will not cause the agreement to fail the Set-in-Advance requirement if it fits the necessary criteria detailed further in the rule. -Alternative Exception for Obstetrical Malpractice Insurance Subsidies—This exception protects the subsidy paid by a hospital, federally qualified health center or rural health clinic if ten requirements are met, including the requirement that the physician's medical practice is located in a primary care Health Professional Shortage Area. -The new ruling places the burden of proof in appeals of Stark-based payment denials on the entity appealing the denial. -Disclosure of Financial Relationships Report (DFRR)— The final rule announces that CMS is proceeding with its proposal to send the DFRR to 500 hospitals.

N.J.’s Biggest Insurer May Turn For-Profit --Industry News--

Sat, 16 Aug 2008 00:00:00 -0400

Horizon Blue Cross Blue Shield has filed for a move that could turn the New Jersey healthcare giant for-profit. The company is New Jersey’s largest healthcare payer, covering fully 40% of New Jersey residents. The conversion is expected to add a billion dollar windfall to the state budget. This influx of cash would go to funding a charity to serve the underserved in New Jersey’s population. Proponents of the proposed status alteration for Horizon say that the for-profit model will maximize operational efficiency and possibly result in lower cost coverage to residents. Opponents predict that the company’s priorities will shift immediately from customers and employers to future shareholders. Non-profit payers generally convert to for-profit when they are looking to expand. Some fear that a merger with another company would shift Horizon’s focus from New Jersey residents to larger markets. Horizon took in $7.5 billion in revenue in 2007, of which $2.5 billion was from for-profit subsidiaries.

22% of Americans Surveyed Cut Visits to Doctor --Industry News--

Wed, 13 Aug 2008 00:00:00 -0400

Nearly one in four Americans have reduced the number of times they’ve gone to see the doctor in order to save money, according to a new poll by the National Association of Insurance Commissioners. The poll, which surveyed 686 consumers in July of 2008, found that 22% of respondents had lessened their trips to the doctor in response to the economy. Furthermore, 11% said they had dropped prescriptions or changed dosages to make the drugs that they did have last longer. These behaviors likely arise from the national trend of health care costs—typically handled through an employer-based system—with more and more being shifted onto employees. As employees are forced to pay more, their healthcare behaviors are changing to compensate. Officials are concerned that initially manageable conditions may become serious due to neglect.

Physicians’ Right of Conscience --Industry News--

Tue, 12 Aug 2008 00:00:00 -0400

Secretary of Health and Human Services Mike Leavitt is in the news again for comments on whether physicians should be required to refer patients to other physicians in a timely manner when the patient’s interest in contraception or abortion conflicts with the physician’s own values. Leavitt questions the American College of Obstetricians and Gynecologists’ (ACOG) perceived desire to take away physicians’ “right of conscience,” which would allow them to refuse to participate in any medical practice they consider a matter of conscience and has drafted new federal laws to protect this right. In November of last year, the ACOG’s Ethics Committee released a statement advising OB/GYNs that they have a duty to refer patients when a conflict of values prevents the desired care. Leavitt’s latest comments in an August blog post have provoked strong reactions. According to Leavitt’s post: This is not a discussion about the rights of a woman to get an abortion. The courts have long ago identified that right and continue to define its limits…This is about the right of a doctor to not participate if he or she chooses for reasons they consider a matter of conscience….Is the fear here that so many doctors will refuse that it will somehow make it difficult for a woman to get an abortion? That hasn’t happened, but what if it did? Wouldn’t that be an important and legitimate social statement? Noting that HHS has yet to make a final decision on the matter, Leavitt emphasized that taking into account a physician’s right of conscience is something that all members of the health profession should respect.

A Decline in Uninsured is Reported for 2007 --Industry News--

Tue, 26 Aug 2008 00:00:00 -0400

The number of Americans without health insurance dropped by a million in 2007 to 45.7 million according to new numbers out from the Census Bureau. The drop comes from a growth in the rolls of those covered by government health insurance programs. The number of people covered privately continued to decline. The Census Bureau’s report does not take the recent economic downturn into account, critics counter. It also, advocates for the poor contend, presents an outdated idea of what constitutes health care coverage. Government officials say that the numbers are indicative of federal programs offsetting the drop in private coverage. The percentage of people covered by the government rose to 27.8% in 2007. The percentage of people covered by Medicaid rose to 13.2%, while the percentage of people covered by private health insurance fell to 67.5%, with employment-based insurance coverage falling to 59.3%. Conservative groups cite the decreasing wages of Hispanic and black Americans as the most newsworthy statistics. Those households have shown significant drops in income, which likely significantly impacted their ability to attain private coverage, even with the assistance of an employer.

Industry Insider: Etiquette tops patients’ checklist --Industry News--

Tue, 12 Aug 2008 00:00:00 -0400

The American Board of Medical Specialties, the nonprofit organization that oversees the board certification of U.S medical specialists, recently surveyed approximately 1,000 adults to identify the physician qualities most desirable to patients. Physician communication and bedside manner was ranked as important by 95% of all respondents. The majority of survey respondents also found board certification to be a highly important physician quality, but only 45% had ever checked to see if a doctor was board certified. Responses to the survey indicate that many survey respondents lack information regarding a number of facets of the medical process, from the process of board certification to doctor qualifications. The majority of respondents noted that they didn’t understand what board certification entailed or meant for physicians, and 60% of respondents incorrectly believed that a doctor had to be board certified to practice medicine. This lack of information on the side of the patient may be due in part to the fact that 57% of the survey respondents reported that they find it difficult to locate useful and clear information on doctors. Additionally, only 31% of respondents said that they ask questions about a doctor’s qualifications, and only 28% of respondents had researched a doctor’s qualifications prior to making an appointment.

Sign In and Pay Now: Insured Patients Finding They Must Put Down Higher Fees Upfront for Care --Industry News--

Tue, 26 Aug 2008 00:00:00 -0400

It’s usually a set process: see the doctor, get a bill later. So why are an increasing number of patients around the nation being asked to pay some money upfront? It’s part of a larger national trend of hospitals asking more upfront from patients, with elective or scheduled procedures now eligible for withholding dependent on the patient’s ability to pay. An informal survey of southern Florida hospitals found all of them requiring upfront payments for elective surgeries, and as insurance companies require higher payments, upfront requests at hospitals go higher and higher. Health insurance premiums are up 78% from 2001 to 2007. Employers continue to cut back benefits or ask employees to contribute more. Hospitals argue that the higher costs go hand-in-hand with higher risks on their part, necessitating the upfront payments. State hospitals spent $2.4 billion on uncompensated care in 2006, up 73% from 2000. As a result, the IRS says that 14% of 481 nonprofit hospitals nationwide require payment or agreement on a payment plan before admittance.

Stanford to Limit Drug Maker Financing --Industry News--

Mon, 25 Aug 2008 00:00:00 -0400

Concerned about the influence of drug companies on medical education, Stanford has announced restrictions on industry financing of continuing medical education at its medical school. While it is common for pharmaceutical companies to fund CME courses, critics claim that they only fund classes that are pushing their latest product. As a response, Stanford no longer allows for pharmaceutical companies to fund specific courses. Rather, all companies contribute to a pool of money that goes to fund all classes. This makes Stanford the sixth major medical school to do such, joining the Universities of Massachusetts, Pittsburg, Colorado, Kansas, and California-Davis. Industry donations were banned at the Memorial Sloan-Kettering Career Center. The move is in response to growing scrutiny of industry financing of continuing medical education. A recent investigation found that drug makers were using classes to push their latest products. The investigations seem to have had an effect, causing some pharmaceutical companies to publicize lists of their grant recipients.

Department Focus—Human Resources: MBAs Among Us --Staffing & Recruitment--

Fri, 15 Aug 2008 00:00:00 -0400

With the realm of health care becoming increasingly complex and profit margins—if even extant—getting thinner and thinner with each passing year, some hospitals are abandoning the old practice of hiring recruits with Masters in Hospital Administration for administration positions, seeking instead candidates with greater business acumen. They’re bringing in MBAs for leadership roles. Such is the case at Houston’s Memorial Hermann Healthcare System, where administrators admit that MHAs tend not to have a full understanding of the market necessities to make healthy decisions for a large hospital. Administrators are beginning to prefer candidates with the ability to look at operational issues and act accordingly. MBAs also, according to administrators, tend to be more ready for leadership roles more quickly. Administrators still won’t say MBAs are the all-around better candidates for 21st Century hospital administration, but the professed popularity among some hospital leaders hints that this may be the beginning of a trend. Indeed, with the exception of some highly specialized clinical roles, some administrators don’t see any place in particular where an MBA couldn’t fit into hospital administration.

The Perfect Hospital CEO from Spare Parts --Staffing & Recruitment--

Mon, 14 Jul 2008 00:00:00 -0400

In an article in Health Leaders Media, author Jim Molpus does a bit of wishful thinking and comes up with the traits that would make up the perfect Chief Executive for the modern hospital. Molpus postulates nine traits deemed indispensable in the modern CEO. All of these rolled into one would result in a Chief Executive who was: -A Servant Leader—A CEO of a hospital should be called to make the institution better above all else, including personal skill development. -Risk-Taker—Having a CEO willing to take risks, but not gamble recklessly, is a critical asset for the successful hospital of the future. -Cheap (but not in a bad way)—With today’s razor thin margins looking to get thinner in the future, there’s no room for decadence. CEOs should be level headed and frugal regarding administrative compensation and perks. -Strong Assistant Coaches—A top-flight senior team is an absolute must. Any CEO who can’t put together a good team should probably start looking for a new line of work. -Attracts People—The CEO doesn’t need to be overwhelmingly charismatic, but should have a personality that attracts people to follow their lead. -Rocks the Babies Once in a While—Reaching out to patients can’t help but improve a hospital’s image. Administrators who not only know this but actively practice it as well are indispensable. -Not Overly Competitive—Being driven is one thing, but winning should always have a purpose. Single-minded pursuit of victory for victory’s sake can result in a loss of sight of what is really important in a hospital: the patients. -Holds Everyone Accountable—Setting a bar for high achievement should include doctors as well as middle managers. -Looks Outside—The CEO should remain aware of what’s going on outside the hospital and work to balance the hospital’s needs and the demands of the larger industry and the community at large.

Partnership: Don’t Let Your Partner Conflict Destroy Your Practice --Employment & Compensation--

Fri, 01 Aug 2008 00:00:00 -0400

Internal practice conflicts can have devastating results for a practice. Conflicts between physicians can arise from disagreements over behavior, compensation, or any number of other issues. Such conflicts can severely damage the functioning of a practice, but an article in Physician Practice reveals some methods of making sure they don’t pop up in the first place. Make sure all sides declare their expectations regarding employment at the beginning. Most partnership agreements don’t specify a number of patients to be seen per month or the amount of call expected. It is hard to get these set in stone, but it is important for at least an informal declaration of expectations on both sides, so that no party feels like he is getting a raw deal from the arrangement. The division of income and patients is a major source of conflicts. In practices with a healthy group dynamic, equal division of income and patient load may work well. Expenses like rent and utilities should be split evenly if possible. Another good way of income division is division based explicitly off productivity. Beware of employing spouses, as that is generally a bad idea. Employing spouses opens the door to the unenviable necessity of disciplining or correcting a colleague’s spouse. Avoid the urge to become “the great dictator” of your practice. People need to be able to confront senior physicians and partners. Deal with behavioral problems. Whether it’s a sassy administrative aide or a hot-shot rainmaker physician, difficult-to-deal-with employees should be dealt with according to an equitably enforced code of conduct. Finally, formalize decisions through votes and committees sized appropriately to the size of your practice. People are less likely to go against decisions if they feel that they were made by group consent. It is thus easier to keep physicians in line and cooperative, especially if they feel they have had some voice in the formulation of policy.

Forming a Legitimate Physician-Hospital Alliance --Employment & Compensation--

Tue, 12 Aug 2008 00:00:00 -0400

Physician-hospital alliances, while something of an increasing trend on the national scene, are often barred by Federal Trade Commission antitrust regulations, but some organizations may have found ways to integrate with the approval of the FTC. Cooperative efforts should be structured to ensure that they are not inherently anti-competitive in order to not risk raising regulatory ire, and clinical integration efforts should show a desire to gain efficiencies and hold down costs, resulting in improved outcomes and benefits for patients. To avoid charges of price fixing, cost arrangements must be simply a means by which efficiencies and patient benefits can be achieved, not an anti-competitive measure. Networks failing at this have been the ones with collective fees not reasonably necessary to achieving any efficiency-enhancing integrations. One manner of avoiding legal complications is to seek an advisory opinion directly from the FTC. Such a path was undertaken by MedSouth in 2002 and Suburban Health Organization in 2006. MedSouth received a go-ahead on their plans, while SHO was informed that their scheme would be in violation of FTC regulations. While the SHO decision may seem like a setback, the denial likely saved the organization much time, trouble, and money in the way of legal troubles. Another example of a successful implementation of clinical integration relates to the Greater Rochester Independent Practice Association (GRIPA). After a request to the FTC for an advisory opinion, the organization proposed the sale of its participating physicians’ services to health plans on a fee-for-service basis. Physicians would still remain free to negotiate and contract separately with plans and patients that did not wish to participate in the GRIPA services. The FTC judged the partnership to have the potential to achieve significant efficiencies and the price controls to be subordinate to the program’s primary goals, thus avoiding charges of price-fixing.